Healthcare Provider Details

I. General information

NPI: 1124840749
Provider Name (Legal Business Name): QUATAVIA SHARNESH ROBINSON CERTIFIED NURSING AS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 NE OKINAWA ST
LAKE CITY FL
32055-1475
US

IV. Provider business mailing address

1078 NE FAMU LN
LAKE CITY FL
32055-2467
US

V. Phone/Fax

Practice location:
  • Phone: 813-787-3040
  • Fax:
Mailing address:
  • Phone: 813-787-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberR152717798800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: