Healthcare Provider Details

I. General information

NPI: 1821092511
Provider Name (Legal Business Name): WILLIAM M SHIMP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD STE 5008
ST AUGUSTINE FL
32086-3705
US

IV. Provider business mailing address

1824 KING ST STE 200
JACKSONVILLE FL
32204-4736
US

V. Phone/Fax

Practice location:
  • Phone: 904-494-2394
  • Fax: 904-400-6676
Mailing address:
  • Phone: 904-384-3343
  • Fax: 904-400-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9101052
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: