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General NPI Number Information
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NPI Number | 1699447094
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Entity Type | Individual
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Provider Name | SHAQUITA TIMMONS CNA
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 4375 YUKON RD
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City | FLORENCE
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State | SC
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Zip | 29505-8949
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Country | US
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Telephone | 843-593-4241
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Fax |
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Provider Business Mailing Address
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Address Line | 4375 YUKON RD
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City | FLORENCE
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State | SC
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Zip | 29505-8949
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Country | US
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Telephone | 843-593-4241
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Fax |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 172702
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 554366
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License Number State | NC
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