Provider Demographics
NPI:1699447094
Name:TIMMONS, SHAQUITA (CNA)
Entity type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:
Last Name:TIMMONS
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 1:4375 YUKON RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-8949
Mailing Address - Country:US
Mailing Address - Phone:843-593-4241
Mailing Address - Fax:
Practice Address - Street 1:4375 YUKON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-8949
Practice Address - Country:US
Practice Address - Phone:843-593-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC172702376K00000X
NC554366376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide