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NPI Code Detail

MEDICARE: NATALIE MIXSON SHALLOW DNP, APRN, FNP-BC

MEDICARE: NATALIE MIXSON SHALLOW DNP, APRN, FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner11006356FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164829768
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATALIE MIXSON SHALLOW DNP, APRN, FNP-BC
Provider Business Mailing Address
First Line : 841 PRUDENTIAL DR STE 1900
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8373
Country : US
Telephone Number : 904-427-8453
Fax Number : 904-633-0958
Provider Business Practice Location Address
First Line : 841 PRUDENTIAL DR STE 1900
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8373
Country : US
Telephone Number : 904-427-8453
Fax Number : 904-633-0958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2014
Last Update Date : 04/12/2024

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