Individual
SHANISE FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 S MARVIN ST, MONTICELLO, FL 32344-2522
(850) 212-3030
Mailing address
2365 CENTERVILLE RD, TALLAHASSEE, FL 32308-4317
(850) 212-3030
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
09/21/2016
Last updated
10/04/2016
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