MEDICARE: QUANISHA CANNON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach
2	172V00000X	Community Health Worker
3	175F00000X	Naturopath
4	175L00000X	Homeopath
5	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	QC23WF5122	FL
6	106S00000X	Behavior Technician
7	133NN1002X	Nutrition Education Nutritionist
8	202D00000X	Integrative Medicine Physician	IM12QC56970	MO
9	251B00000X	Case Management Agency
10	251G00000X	Community Based Hospice Care Agency
11	251S00000X	Community/Behavioral Health Agency
12	332B00000X	Durable Medical Equipment & Medical Supplies
13	374J00000X	Doula
14	374K00000X	Religious Nonmedical Practitioner

General Provider Information

NPI Number	:	1558179515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUANISHA CANNON

Provider Business Mailing Address
First Line	:	3702 W SPRUCE ST # 1117
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2553
Country	:	US
Telephone Number	:	800-303-4214
Fax Number	:

Provider Business Practice Location Address
First Line	:	3702 W SPRUCE ST # 1117
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2553
Country	:	US
Telephone Number	:	800-303-4214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	01/13/2025

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Directions to “ QUANISHA CANNON ” Practice Location

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