Provider Demographics
NPI:1861019341
Name:HUTCHINSON, SHAKIRIA RENEA (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:SHAKIRIA
Middle Name:RENEA
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 OLD OAK TREE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-5991
Mailing Address - Country:US
Mailing Address - Phone:407-393-7825
Mailing Address - Fax:
Practice Address - Street 1:4845 OLD OAK TREE CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-5991
Practice Address - Country:US
Practice Address - Phone:407-393-7825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH325796897821Medicaid