Individual provider Active NPI

Tamika Francina Clemetson, LPN

  • Licensed Practical Nurse
  • Bronx, NY
National Provider Identifier
1891197851
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
302661-1 Issued in NY
Practice address
2054 Tillotson Ave
Suite 102
Bronx, NY 10475-1560
Phone
(718) 671-2100
Fax
(347) 964-0790
NPI assigned
Sep 22, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 302661-1 NY Primary

Addresses

Primary practice location

2054 Tillotson Ave
Suite 102
Bronx, NY 10475-1560

Mailing address

1816 E 53Rd St
2ND Floor
Brooklyn, NY 11234-4620
Phone (347) 587-4858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
302661-1NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1891197851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1816 E 53RD ST",
            "address_2": "2ND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344620",
            "telephone_number": "347-587-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2054 TILLOTSON AVE",
            "address_2": "SUITE 102",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104751560",
            "telephone_number": "718-671-2100",
            "fax_number": "347-964-0790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMETSON",
        "first_name": "TAMIKA",
        "middle_name": "FRANCINA",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-22",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "302661-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.