Provider Demographics
NPI:1861143828
Name:JACKSON-RICHMOND, TANIKA S (DNP,MSN,ED,RN,CEO)
Entity type:Individual
Prefix:DR
First Name:TANIKA
Middle Name:S
Last Name:JACKSON-RICHMOND
Suffix:
Gender:F
Credentials:DNP,MSN,ED,RN,CEO
Other - Prefix:DR
Other - First Name:TANIKA
Other - Middle Name:SHAKITA
Other - Last Name:JACKSON-RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TANIKA JACKSON
Mailing Address - Street 1:5226 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9335
Mailing Address - Country:US
Mailing Address - Phone:813-352-8824
Mailing Address - Fax:813-422-7973
Practice Address - Street 1:3420 DELEUIL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-3621
Practice Address - Country:US
Practice Address - Phone:813-352-8824
Practice Address - Fax:813-422-7973
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9350602163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development