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NPI Code Detail

MEDICARE: MS. TAMIKA C RANDALL LPN

MEDICARE: MS. TAMIKA C RANDALL LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse249194NY

General Provider Information

NPI Number : 1093969909
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMIKA C RANDALL LPN
Provider Business Mailing Address
First Line : 10820 164TH ST
Second Line : 2ND FLOOR
City : JAMAICA
State : NY
Zip : 11433-2827
Country : US
Telephone Number : 718-487-3010
Fax Number :
Provider Business Practice Location Address
First Line : 13 CLEVELAND ST
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11580-6003
Country : US
Telephone Number : 516-823-0739
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2008
Last Update Date : 06/13/2011

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