Individual
ANTONNI LASHAE SHINGLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1360 BEAVER TRAIL DR, CORDOVA, TN 38016-9601
(901) 754-2927
Mailing address
1360 BEAVER TRAIL DR, CORDOVA, TN 38016-9601
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 149251
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
14807
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003143843
CHAMPUS/TRICARE
—
05
—
1519463
—
TN
01
—
187026001
ARKANSAS MEDICAID
AR
01
—
4252851
BLUE CROSS OF TN
TN
Enumeration date
11/16/2009
Last updated
07/11/2011
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