Individual
LAQUANTA DENITRIS SHANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4505 GILBERT ST, JACKSONVILLE, FL 32207-6707
(904) 219-7791
Mailing address
4505 GILBERT ST, JACKSONVILLE, FL 32207-6707
(904) 219-7791
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
—
372500000X
Chore Provider
—
—
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-4168752
—
FL
Enumeration date
02/24/2018
Last updated
06/16/2018
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