Provider Demographics
NPI:1235431891
Name:KOHN, SHONTEE M (CNA)
Entity Type:Individual
Prefix:
First Name:SHONTEE
Middle Name:M
Last Name:KOHN
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-3712
Mailing Address - Country:US
Mailing Address - Phone:904-226-4266
Mailing Address - Fax:
Practice Address - Street 1:1745 W 28TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-3712
Practice Address - Country:US
Practice Address - Phone:904-226-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL258751372600000X
FL374U00000X
FL2875414376J00000X
FL178494376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker