Active NPI
Shenita McCrimager
- Home Health Aide
- Jacksonville, FL
National Provider Identifier
1174103154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- 2662
- Practice address
- 1655 Prudential Dr
Jacksonville, FL 32207-8105 - Phone
- (904) 403-1335
- NPI assigned
- Apr 13, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 2662 | FL | Primary |
Addresses
Primary practice location
1655 Prudential Dr
Jacksonville, FL 32207-8105
Mailing address
1655 Prudential Dr
Jacksonville, FL 32207-8105
Phone (904) 403-1335
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 854248764 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2662 | FL | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618272000000",
"number": "1174103154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1655 PRUDENTIAL DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078105",
"telephone_number": "904-403-1335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1655 PRUDENTIAL DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078105",
"telephone_number": "904-403-1335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCRIMAGER",
"first_name": "SHENITA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-13",
"last_updated": "2021-04-13",
"certification_date": "2021-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "FL",
"license": "2662",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "854248764",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.