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General NPI Number Information
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NPI Number | 1891449344
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Entity Type | Individual
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Provider Name | SHANEIQUA SHANTEL CRENSHAW CNA
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Gender | Female
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 7000 COBBLE CRK
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City | PENSACOLA
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State | FL
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Zip | 32504-8638
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Country | US
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Telephone | 850-288-5993
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Fax |
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Provider Business Mailing Address
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Address Line | 901 MASSACHUSETTS AVE LOT 21
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City | PENSACOLA
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State | FL
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Zip | 32505-3824
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Country | US
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Telephone | 850-288-5993
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | CNA331095
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License Number State | FL
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