Provider Demographics
NPI:1447425053
Name:STARKS, SHAQUITA ANTONETTE (NP)
Entity Type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:ANTONETTE
Last Name:STARKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:QUITA
Other - Middle Name:
Other - Last Name:STARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:12 EXECUTIVE PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2206
Mailing Address - Country:US
Mailing Address - Phone:404-712-6929
Mailing Address - Fax:404-712-0278
Practice Address - Street 1:12 EXECUTIVE PARK DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-712-6929
Practice Address - Fax:404-712-0278
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810588363LF0000X
GA166901363LP0808X
TN13364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily