Provider Demographics
NPI:1952934135
Name:JEFFERSON, SHAKITTA DENISE (MSN, CRNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHAKITTA
Middle Name:DENISE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:SHAKITTA
Other - Middle Name:DENISE
Other - Last Name:PLANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:1010 W LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-1640
Mailing Address - Country:US
Mailing Address - Phone:267-273-7000
Mailing Address - Fax:
Practice Address - Street 1:1010 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-1640
Practice Address - Country:US
Practice Address - Phone:267-273-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily