Provider Demographics
NPI:1881187672
Name:SHEPARD, JACQUELINE CRADY (CNA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:CRADY
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:CRADY
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:85147 CRADY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6849
Mailing Address - Country:US
Mailing Address - Phone:904-646-7576
Mailing Address - Fax:
Practice Address - Street 1:85147 CRADY LAKE DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6849
Practice Address - Country:US
Practice Address - Phone:904-646-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA254629372500000X, 372600000X, 374U00000X, 376K00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide