MEDICARE: MRS. TIKA MONIQUE ALLEN NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	RN204536	GA

General Provider Information

NPI Number	:	1598348674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIKA MONIQUE ALLEN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1567 JANMAR RD STE 100
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-0308
Country	:	US
Telephone Number	:	770-972-1022
Fax Number	:

Provider Business Practice Location Address
First Line	:	1567 JANMAR RD STE 100
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-0308
Country	:	US
Telephone Number	:	770-972-1022
Fax Number	:	770-407-8584

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	02/17/2026

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