MEDICARE: SHAYLA RAE APRN

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	163W00000X	Registered Nurse	131158	IA
2	363L00000X	Nurse Practitioner	GAA-NP005031	GA
3	363LW0102X	Women's Health Nurse Practitioner	F131158	IA
4	367A00000X	Advanced Practice Midwife	B131158	IA

General Provider Information

NPI Number	:	1942713888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLA RAE APRN

Provider Business Mailing Address
First Line	:	16 PINDO PALM DR
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-6085
Country	:	US
Telephone Number	:	641-919-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	186 SOUTHERN OAK DR
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-8365
Country	:	US
Telephone Number	:	641-919-8889
Fax Number	:

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

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	05/07/2026

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