Healthcare Provider Details

I. General information

NPI: 1700591633
Provider Name (Legal Business Name): SHELLEY RENEE COLLINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 SW ARCHER RD FL 32608
GAINESVILLE FL
32608-1316
US

IV. Provider business mailing address

11491 SW 70TH PL
CEDAR KEY FL
32625-2502
US

V. Phone/Fax

Practice location:
  • Phone: 352-554-2000
  • Fax:
Mailing address:
  • Phone: 352-325-0538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9509768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: