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General NPI Number Information
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NPI Number | 1477001071
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Entity Type | Individual
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Provider Name | SHONTRELL DENISE CORKER
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Gender | Female
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 04/29/2023
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Provider Practice Location Address
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Address Line | 2915 JACKSON ST APT 3
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4755
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Country | US
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Telephone | 954-662-9447
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Fax | 954-923-4926
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Provider Business Mailing Address
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Address Line | 2241 N MONROE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32303-4731
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Country | US
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Telephone | 954-662-9447
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Fax | 954-923-4926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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