MEDICARE: WILLIAM M SHIMP PA-C

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	363AS0400X	Surgical Physician Assistant	PA9101052	FL
2	363A00000X	Physician Assistant	PA9101052	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1821092511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM M SHIMP PA-C

Provider Business Mailing Address
First Line	:	1824 KING ST STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4736
Country	:	US
Telephone Number	:	904-384-3343
Fax Number	:	904-400-6671

Provider Business Practice Location Address
First Line	:	300 HEALTH PARK BLVD STE 5008
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-3705
Country	:	US
Telephone Number	:	904-494-2394
Fax Number	:	904-400-6676

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/09/2025

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Directions to “ WILLIAM M SHIMP PA-C” Practice Location

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