Individual
TAMIKA MICKIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
680 BLAIR MILL RD, HORSHAM, PA 19044-2223
(484) 781-5933
Mailing address
3725 ROSEMONT AVE, DREXEL HILL, PA 19026-3009
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN635596
PA
363LG0600X
Gerontology Nurse Practitioner
Primary
SP022939
PA
Other
Enumeration date
04/06/2021
Last updated
04/23/2021
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