Healthcare Provider Details

I. General information

NPI: 1861143828
Provider Name (Legal Business Name): TANIKA S JACKSON-RICHMOND DNP,MSN,ED,RN,CEO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANIKA SHAKITA JACKSON-RICHMOND TANIKA JACKSON

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 DELEUIL AVE
TAMPA FL
33610-3621
US

IV. Provider business mailing address

5226 WILLIAMS RD
TAMPA FL
33610-9335
US

V. Phone/Fax

Practice location:
  • Phone: 813-352-8824
  • Fax: 813-422-7973
Mailing address:
  • Phone: 813-352-8824
  • Fax: 813-422-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN9350602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: