Individual provider Active NPI

Shereka Jackson Martin, C.N.A

  • Nurse's Aide
  • Fort Pierce, FL
National Provider Identifier
1679728760
Registry record updated Mar 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse's AideTaxonomy code 376K00000X
License
CNA 129843 Issued in FL
Practice address
606 N 18TH Street
Fort Pierce, FL 34950-6013
Phone
(772) 882-9450
Fax
(717) 924-5632
NPI assigned
Nov 18, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse's Aide 376K00000X CNA 129843 FL Primary

Addresses

Primary practice location

606 N 18TH Street
Fort Pierce, FL 34950-6013

Mailing address

606 N 18TH Street
Fort Pierce, FL 34950-6013
Phone (772) 882-9450

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

LicenseStateTypeSpecialty
CNA 129843FLMDNurse's Aide

NPI Registry JSON

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

{
    "created_epoch": "1226966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237334400000",
    "number": "1679728760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 N 18TH STREET",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349506013",
            "telephone_number": "772-882-9450",
            "fax_number": "717-924-5632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 N 18TH STREET",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349506013",
            "telephone_number": "772-882-9450",
            "fax_number": "717-924-5632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "SHEREKA",
        "middle_name": "JACKSON",
        "name_prefix": "Mrs.",
        "credential": "C.N.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-18",
        "last_updated": "2009-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "FL",
            "license": "CNA 129843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; 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.