Provider Demographics
NPI:1164718797
Name:HILL, SHUMEKA TAREESA (APN)
Entity Type:Individual
Prefix:
First Name:SHUMEKA
Middle Name:TAREESA
Last Name:HILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5285 VILLA LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1349
Mailing Address - Country:US
Mailing Address - Phone:773-954-4476
Mailing Address - Fax:470-239-1128
Practice Address - Street 1:5285 VILLA LAKE CT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1349
Practice Address - Country:US
Practice Address - Phone:773-954-4476
Practice Address - Fax:470-239-1128
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041352323363LA2100X
GARN189379363LF0000X
IN71006247A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty