Healthcare Provider Details

I. General information

NPI: 1114782018
Provider Name (Legal Business Name): SHATARA LOUISE VEREEN CHW, CD, CHHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 25TH AVE STE 403
OCALA FL
34470-5668
US

IV. Provider business mailing address

8316 SW 136TH ST
OCALA FL
34473-6836
US

V. Phone/Fax

Practice location:
  • Phone: 352-209-5126
  • Fax:
Mailing address:
  • Phone: 352-209-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCCHW.0100478
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number202311260
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: