Healthcare Provider Details

I. General information

NPI: 1679193940
Provider Name (Legal Business Name): SHWETABEN P PATEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W 8TH ST FL I8
JACKSONVILLE FL
32209-6533
US

IV. Provider business mailing address

580 W 8TH ST FL I8
JACKSONVILLE FL
32209-6533
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1022
  • Fax: 904-244-9439
Mailing address:
  • Phone: 904-383-1022
  • Fax: 904-244-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004697
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11004697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: