Provider Demographics
NPI:1114734142
Name:COCKERHAM, FAWANTINA
Entity type:Individual
Prefix:
First Name:FAWANTINA
Middle Name:
Last Name:COCKERHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 LELAND RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-3658
Mailing Address - Country:US
Mailing Address - Phone:850-867-4287
Mailing Address - Fax:
Practice Address - Street 1:2842 LELAND RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-3658
Practice Address - Country:US
Practice Address - Phone:850-867-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula