Provider Demographics
NPI:1740155779
Name:TOOLEY, SHAWNITA
Entity type:Individual
Prefix:
First Name:SHAWNITA
Middle Name:
Last Name:TOOLEY
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 1:15938 BAINEBRIGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-3019
Mailing Address - Country:US
Mailing Address - Phone:463-274-7444
Mailing Address - Fax:
Practice Address - Street 1:15938 BAINEBRIGE DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3019
Practice Address - Country:US
Practice Address - Phone:463-274-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide