Provider Demographics
NPI:1679728760
Name:MARTIN, SHEREKA JACKSON (CNA)
Entity Type:Individual
Prefix:MRS
First Name:SHEREKA
Middle Name:JACKSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 N 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-6013
Mailing Address - Country:US
Mailing Address - Phone:772-882-9450
Mailing Address - Fax:717-924-5632
Practice Address - Street 1:606 N 18TH STREET
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-6013
Practice Address - Country:US
Practice Address - Phone:772-882-9450
Practice Address - Fax:717-924-5632
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 129843376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide