Provider Demographics
NPI:1912650995
Name:MORANT, SHANTASHA
Entity Type:Individual
Prefix:
First Name:SHANTASHA
Middle Name:
Last Name:MORANT
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 1:15735 SW 52ND AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-3149
Mailing Address - Country:US
Mailing Address - Phone:352-299-7634
Mailing Address - Fax:
Practice Address - Street 1:15735 SW 52ND AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-3149
Practice Address - Country:US
Practice Address - Phone:352-299-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN526421164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse