Healthcare Provider Details

I. General information

NPI: 1891449344
Provider Name (Legal Business Name): SHANEIQUA SHANTEL CRENSHAW CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 COBBLE CRK
PENSACOLA FL
32504-8638
US

IV. Provider business mailing address

901 MASSACHUSETTS AVE LOT 21
PENSACOLA FL
32505-3824
US

V. Phone/Fax

Practice location:
  • Phone: 850-288-5993
  • Fax:
Mailing address:
  • Phone: 850-288-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberCNA331095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: