Healthcare Provider Details
I. General information
NPI: 1942713888
Provider Name (Legal Business Name): SHAYLA RAE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 11/14/2017
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
186 SOUTHERN OAK DR
PONTE VEDRA FL
32081-8365
US
IV. Provider business mailing address
16 PINDO PALM DR
PONTE VEDRA FL
32081-6085
US
V. Phone/Fax
- Phone: 641-919-8889
- Fax:
- Phone: 641-919-8889
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | GAA-NP005031 |
| License Number State | GA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | 500341786 |
| License Number State | DC |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | 11024512 |
| License Number State | FL |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | 0024195267 |
| License Number State | VA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 987279 |
| License Number State | NY |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | 1195791 |
| License Number State | TX |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 131158 |
| License Number State | IA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 9637443 |
| License Number State | FL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | F131158 |
| License Number State | IA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | 42622 |
| License Number State | TN |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 367A00000X |
| Taxonomy | Advanced Practice Midwife |
| License Number | B131158 |
| License Number State | IA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 500341786 |
| License Number State | DC |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | AC008712 |
| License Number State | MD |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | 0041939 |
| License Number State | OH |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
