Provider Demographics
NPI:1700341435
Name:SMITH, SHERIKA LASHAY (LPN)
Entity Type:Individual
Prefix:
First Name:SHERIKA
Middle Name:LASHAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33870 BLUE STAR HWY APT 1106
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-2434
Mailing Address - Country:US
Mailing Address - Phone:850-895-7563
Mailing Address - Fax:850-999-8393
Practice Address - Street 1:33870 BLUE STAR HWY APT 1106
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:FL
Practice Address - Zip Code:32343-2434
Practice Address - Country:US
Practice Address - Phone:850-895-7563
Practice Address - Fax:850-999-8393
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5187925164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse