Provider Demographics
NPI:1558192989
Name:COLEMAN, SHAQUITA (FNP)
Entity type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 VALLEYGATE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3571
Mailing Address - Country:US
Mailing Address - Phone:910-486-8880
Mailing Address - Fax:910-486-8886
Practice Address - Street 1:1905 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0260
Practice Address - Country:US
Practice Address - Phone:910-864-4357
Practice Address - Fax:910-221-0099
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF05240634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily