Individual
TYKESHIA ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS, 2005 KNIGHT LANE BLDG H, JACKSONVILLE, FL 32212-0140
(760) 725-3213
Mailing address
NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS, 2005 KNIGHT LANE BLDG H, JACKSONVILLE, FL 32212-0140
(760) 725-3213
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369927759
EDIPI
—
Enumeration date
12/06/2019
Last updated
12/06/2019
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