Healthcare Provider Details

I. General information

NPI: 1952492498
Provider Name (Legal Business Name): TAMIKA CUMMINGS-PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 SW 74TH AVE
NORTH LAUDERDALE FL
33068-3609
US

IV. Provider business mailing address

PO BOX 590115
FT LAUDERDALE FL
33359-0115
US

V. Phone/Fax

Practice location:
  • Phone: 954-648-6919
  • Fax: 954-722-3405
Mailing address:
  • Phone: 954-648-6919
  • Fax: 954-722-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: