Provider Demographics
NPI:1427600642
Name:POPE, SHAKEDIA SHANTA
Entity Type:Individual
Prefix:
First Name:SHAKEDIA
Middle Name:SHANTA
Last Name:POPE
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 1:3050 E KINGSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9769
Mailing Address - Country:US
Mailing Address - Phone:850-554-4828
Mailing Address - Fax:
Practice Address - Street 1:3050 E KINGSFIELD RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9769
Practice Address - Country:US
Practice Address - Phone:850-554-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9254451163W00000X
FLAPRN11004922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse