Provider Demographics
NPI:1073198552
Name:MIKE, CHA'SANI
Entity Type:Individual
Prefix:
First Name:CHA'SANI
Middle Name:
Last Name:MIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 ROBERTS AVE LOT 232
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-5045
Mailing Address - Country:US
Mailing Address - Phone:850-933-2362
Mailing Address - Fax:
Practice Address - Street 1:3535 ROBERTS AVE LOT 232
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-5045
Practice Address - Country:US
Practice Address - Phone:850-933-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide