Shantrell Nicole Cobb

Primary specialty

HomemakerTaxonomy code 376J00000X

License

238101 Issued in FL

Practice address

623 Long Branch Blvd
Jacksonville, FL 32206-6252

Phone

(904) 571-7843

NPI assigned

Nov 8, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shantrell Nicole Cobb Former name

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.

• Genuinely Blessed Hands LLC

  • In Home Supportive Care Agency
  • Jacksonville, FL
  • NPI 1265191548

  Homemaker

  NPD Authorized official

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1932864550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 LONG BRANCH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322066252",
            "telephone_number": "904-582-6209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 LONG BRANCH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322066252",
            "telephone_number": "904-571-7843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBB",
        "first_name": "SHANTRELL",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-08",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "FL",
            "license": "238101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932864550",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANTRELL",
            "last_name": "COBB",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charles Gary Cobb, MD
• Coleen Cobb, OTR/L
• John Cobb, APRN
• Ladarrian Cobb, OT
• Samantha N Cobb
• Tabitha Cobb
• Theresa Cobbs
• Ryan Cocca, MD
• Benjamin P Cochran, MD
• Breanna Nicole Cochran

• 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 Jul 25, 2022; 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.