MEDICARE: MRS. SHELA BAZILE ANP-BC, MSN, RN

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
1	363LA2200X	Adult Health Nurse Practitioner	10007556	OR
2	363LA2200X	Adult Health Nurse Practitioner	GAA-NP000009	GA
3	363LA2200X	Adult Health Nurse Practitioner	0024189534	VA
4	363LA2200X	Adult Health Nurse Practitioner	ARNP 9236018	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ARNP9236018	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1780022590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELA BAZILE ANP-BC, MSN, RN

Provider Business Mailing Address
First Line	:	658 SW DALTON CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-5813
Country	:	US
Telephone Number	:	772-626-5937
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 FAIRWAY DR
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1828
Country	:	US
Telephone Number	:	954-606-5217
Fax Number	:	888-503-1690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	01/08/2025

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