Individual
TANIKA JANAE KEAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
568 9TH ST, IMPERIAL BEACH, CA 91932-1544
(757) 822-9965
Mailing address
568 9TH ST, IMPERIAL BEACH, CA 91932-1544
(757) 822-9965
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
0024191131
VA
Other
Enumeration date
12/16/2024
Last updated
12/16/2024
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