Healthcare Provider Details

I. General information

NPI: 1356886949
Provider Name (Legal Business Name): TAMIKA HARRIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UAB COMMUNITY PSYCHIATRY 908 20TH STREET SOUTH RM 487
BIRMINGHAM AL
35294-0001
US

IV. Provider business mailing address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3478
  • Fax: 205-975-8950
Mailing address:
  • Phone: 256-288-3333
  • Fax: 256-288-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1-140820
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-140820
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: