MEDICARE: MS. QUINTA TENGU TIKUM

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	376K00000X	Nurse's Aide	A00233028	MD

General Provider Information

NPI Number	:	1700749678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. QUINTA TENGU TIKUM

Provider Business Mailing Address
First Line	:	7001 96TH AVE
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3615
Country	:	US
Telephone Number	:	240-459-8743
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 96TH AVE
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3615
Country	:	US
Telephone Number	:	240-459-8743
Fax Number	:

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

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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