Healthcare Provider Details

I. General information

NPI: 1952946519
Provider Name (Legal Business Name): SHAUN EGGLESTON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 01/10/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

200 MERCY CIRCLE
CAMP PENDLETON CA
92058-4980
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013196
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247004
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number832488
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: