Healthcare Provider Details

I. General information

NPI: 1275026569
Provider Name (Legal Business Name): TAMIKA ERICA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 BRIGGS CHANEY RD
SILVER SPRING MD
20904
US

IV. Provider business mailing address

3300 BRIGGS CHANEY RD
SILVER SPRING MD
20904-4811
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-2400
  • Fax:
Mailing address:
  • Phone: 301-493-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR145532
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: