Healthcare Provider Details

I. General information

NPI: 1841616489
Provider Name (Legal Business Name): TYKISE LAJUAN ROBBINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TYKISE LAJUAN ROBBINS FNP

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 COVINGTON PIKE
MEMPHIS TN
38128-6007
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 901-425-0200
  • Fax: 901-213-9868
Mailing address:
  • Phone: 562-977-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18495
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: