Provider Demographics
NPI:1144855503
Name:BARBER, TYKIA ALEXIS
Entity type:Individual
Prefix:
First Name:TYKIA
Middle Name:ALEXIS
Last Name:BARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 W OAK RIDGE RD APT 205
Mailing Address - Street 2:
Mailing Address - City:PINE CASTLE
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4068
Mailing Address - Country:US
Mailing Address - Phone:407-318-4727
Mailing Address - Fax:
Practice Address - Street 1:428 W OAK RIDGE RD APT 205
Practice Address - Street 2:
Practice Address - City:PINE CASTLE
Practice Address - State:FL
Practice Address - Zip Code:32809-4068
Practice Address - Country:US
Practice Address - Phone:407-318-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator