Provider Demographics
NPI:1376957514
Name:SHEPHARD, LUISA
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:SHEPHARD
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 1:6505 SAWYER CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4957
Mailing Address - Country:US
Mailing Address - Phone:813-850-6511
Mailing Address - Fax:813-888-5405
Practice Address - Street 1:6505 SAWYER CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4957
Practice Address - Country:US
Practice Address - Phone:813-850-6511
Practice Address - Fax:813-888-5405
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3332374U00000X
FL173724376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide