Provider Demographics
NPI:1538021985
Name:JOHNSON, SHANQELLE
Entity type:Individual
Prefix:
First Name:SHANQELLE
Middle Name:
Last Name:JOHNSON
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 1:1308 W CHESTNUT ST APT 212
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4442
Mailing Address - Country:US
Mailing Address - Phone:813-539-1477
Mailing Address - Fax:
Practice Address - Street 1:1308 W CHESTNUT ST APT 212
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4442
Practice Address - Country:US
Practice Address - Phone:813-539-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3723223747P1801X, 376K00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374J00000XNursing Service Related ProvidersDoula