Healthcare Provider Details

I. General information

NPI: 1538021985
Provider Name (Legal Business Name): SHANQELLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date: 06/30/2026
Reactivation Date: 07/23/2026

III. Provider practice location address

1308 W CHESTNUT ST APT 212
TAMPA FL
33607-4442
US

IV. Provider business mailing address

1308 W CHESTNUT ST APT 212
TAMPA FL
33607-4442
US

V. Phone/Fax

Practice location:
  • Phone: 813-539-1477
  • Fax:
Mailing address:
  • Phone: 813-539-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number372322
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number372322
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number372322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: