Provider Demographics
NPI:1154966687
Name:PARKER, SHAQUANDA (CNA)
Entity type:Individual
Prefix:
First Name:SHAQUANDA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4989 AVIENDA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34946-1031
Mailing Address - Country:US
Mailing Address - Phone:772-400-1888
Mailing Address - Fax:
Practice Address - Street 1:4989 AVIENDA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34946-1031
Practice Address - Country:US
Practice Address - Phone:772-400-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide