1841616489 NPI number — MRS. TYKISE LAJUAN ROBBINS FNP

Table of content: MRS. TYKISE LAJUAN ROBBINS FNP (NPI 1841616489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841616489 NPI number — MRS. TYKISE LAJUAN ROBBINS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBBINS
Provider First Name:
TYKISE
Provider Middle Name:
LAJUAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBBINS
Provider Other First Name:
TYKISE
Provider Other Middle Name:
LAJUAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841616489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12900 PARK PLAZA DR STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-9329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-977-4674
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2922 COVINGTON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38128-6007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-425-0200
Provider Business Practice Location Address Fax Number:
901-213-9868
Provider Enumeration Date:
03/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  18495 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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