Provider Demographics
NPI:1124840749
Name:ROBINSON, QUATAVIA SHARNESH (CERTIFIED NURSING AS)
Entity type:Individual
Prefix:MS
First Name:QUATAVIA
Middle Name:SHARNESH
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CERTIFIED NURSING AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 NE FAMU LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-2467
Mailing Address - Country:US
Mailing Address - Phone:813-787-3040
Mailing Address - Fax:
Practice Address - Street 1:186 NE OKINAWA ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-1475
Practice Address - Country:US
Practice Address - Phone:813-787-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR152717798800172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver