Individual
SHANTRELL NICOLE COBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
623 LONG BRANCH BLVD, JACKSONVILLE, FL 32206-6252
(904) 571-7843
Mailing address
623 LONG BRANCH BLVD, JACKSONVILLE, FL 32206-6252
(904) 582-6209
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
238101
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932864550
—
FL
Enumeration date
11/08/2021
Last updated
07/25/2022
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