Individual
TARKESHIA SHUMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3150 BROADWAY AVE, JACKSOVILLE, FL 32254
(904) 570-8601
Mailing address
3150 BROADWAY AVE, JACKSONVILLE, FL 32254-3106
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010644000
—
FL
05
—
S550-804-88-585-0
—
FL
05
—
S550804885850
—
FL
Enumeration date
06/08/2017
Last updated
10/05/2022
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