Healthcare Provider Details

I. General information

NPI: 1093815599
Provider Name (Legal Business Name): SHIRL RENAE ROGERS ARNP, CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S MARION AVE WOUND CLINIC
LAKE CITY FL
32025-5808
US

IV. Provider business mailing address

8981 SW 84TH ST
GAINESVILLE FL
32608-7223
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3016
  • Fax: 386-719-3617
Mailing address:
  • Phone: 386-755-3016
  • Fax: 386-719-3617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number564015
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: