Provider Demographics
NPI:1114236098
Name:HODGES, SHIMEAKA DANIELLE-GARRETT (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHIMEAKA
Middle Name:DANIELLE-GARRETT
Last Name:HODGES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SHIMEAKA
Other - Middle Name:DANIELLE
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263
Mailing Address - Country:US
Mailing Address - Phone:661-746-5788
Mailing Address - Fax:661-746-5273
Practice Address - Street 1:406 JAMES ST
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263
Practice Address - Country:US
Practice Address - Phone:661-746-5788
Practice Address - Fax:661-746-5273
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant