Healthcare Provider Details

I. General information

NPI: 1194356139
Provider Name (Legal Business Name): ESTER SHUPE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 GEORGIA ST
STARKE FL
32091-1816
US

IV. Provider business mailing address

23343 NW COUNTY ROAD 236
HIGH SPRINGS FL
32643-9669
US

V. Phone/Fax

Practice location:
  • Phone: 904-364-2900
  • Fax: 904-364-2901
Mailing address:
  • Phone: 352-463-2374
  • Fax: 352-463-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: