Tysheana Peterson

Primary specialty

HomemakerTaxonomy code 376J00000X

License

236899 Issued in FL

Practice address

6717 Southern Oaks Dr
Jacksonville, FL 32244-3675

Phone

(904) 575-5082

NPI assigned

Jul 30, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sheanas Care Support LLC

  • Homemaker
  • Jacksonville, FL
  • NPI 1740851435

  Chore Provider

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1154930527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 440222",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322220021",
            "telephone_number": "904-575-5082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6717 SOUTHERN OAKS DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322443675",
            "telephone_number": "904-575-5082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TYSHEANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-30",
        "last_updated": "2021-09-17",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "FL",
            "license": "236899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "t.peterson@sheanacaresupport.com",
            "affiliation": "N",
            "endpointDescription": "domain",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6717 Southern Oaks Dr",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322443675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.sheanacaresupport.com",
            "affiliation": "N",
            "address_1": "6717 Southern Oaks Dr",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322443675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lynn Peterson
• Mary Peterson, ADMINISTRATOR
• Michael Peterson
• Richard Kenneth Peterson, M.D.
• Ruby D Peterson
• Lynn-Shaina Petit-Frere
• Petite Consulting Inc
• Michael J Petr, MD, PHD
• Kimberly Marie Petragnani, ARNP
• Ylan Petranick

• Homemaker in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Homemaker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.