Provider Demographics
NPI:1881349314
Name:MACK, SHERIKA
Entity type:Individual
Prefix:
First Name:SHERIKA
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5758 NW 63RD PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-7657
Mailing Address - Country:US
Mailing Address - Phone:352-301-0642
Mailing Address - Fax:
Practice Address - Street 1:6921 NW 22ND ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-1228
Practice Address - Country:US
Practice Address - Phone:352-554-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104017500373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL320900000XOtherHOME AND COMMUNITY BASED SERVICES WAIVER
FL104017500Medicaid
FL320900000XMedicaid