MEDICARE: TANIKA SCOTT-JACKSOM

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
1	343900000X	Non-emergency Medical Transport (VAN)
2	343900000X	Non-emergency Medical Transport (VAN)		VA

General Provider Information

NPI Number	:	1437904323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIKA SCOTT-JACKSOM

Provider Business Mailing Address
First Line	:	4108 E PARHAM RD STE 100
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2754
Country	:	US
Telephone Number	:	804-206-3034
Fax Number	:

Provider Business Practice Location Address
First Line	:	4108 E PARHAM RD STE 100
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2754
Country	:	US
Telephone Number	:	804-206-3034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

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Directions to “ TANIKA SCOTT-JACKSOM ” Practice Location

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