Healthcare Provider Details

I. General information

NPI: 1811894827
Provider Name (Legal Business Name): AUSTIN SHOCKLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2026
Last Update Date: 10/22/2026
Certification Date: 10/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SIMMONS LOOP
RIVERVIEW FL
33578-9498
US

IV. Provider business mailing address

10501 VILLA VIEW CIR
TAMPA FL
33647-2599
US

V. Phone/Fax

Practice location:
  • Phone: 941-713-2986
  • Fax:
Mailing address:
  • Phone: 941-713-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License NumberPS66210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: