Healthcare Provider Details

I. General information

NPI: 1851698278
Provider Name (Legal Business Name): ANITA R SHELDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 THE GREENS WAY UNIT 108
JACKSONVILLE BEACH FL
32250-2451
US

IV. Provider business mailing address

1800 THE GREENS WAY UNIT 108
JACKSONVILLE BEACH FL
32250-2451
US

V. Phone/Fax

Practice location:
  • Phone: 904-373-0230
  • Fax: 904-373-0230
Mailing address:
  • Phone: 904-373-0230
  • Fax: 904-373-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN669142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: