Provider Demographics
NPI:1477001071
Name:CORKER, SHONTRELL DENISE
Entity Type:Individual
Prefix:
First Name:SHONTRELL
Middle Name:DENISE
Last Name:CORKER
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 1:2241 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4731
Mailing Address - Country:US
Mailing Address - Phone:954-662-9447
Mailing Address - Fax:954-923-4926
Practice Address - Street 1:2915 JACKSON ST APT 3
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4755
Practice Address - Country:US
Practice Address - Phone:954-662-9447
Practice Address - Fax:954-923-4926
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide