Provider Demographics
NPI:1316436751
Name:RICHBURGH, SHAKIRA (LPN)
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:
Last Name:RICHBURGH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5763 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-2013
Mailing Address - Country:US
Mailing Address - Phone:904-214-2282
Mailing Address - Fax:904-485-8541
Practice Address - Street 1:14091 SUMMER BREEZE DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8913
Practice Address - Country:US
Practice Address - Phone:804-502-5840
Practice Address - Fax:904-458-8541
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5229863164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse