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General NPI Number Information
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NPI Number | 1023833555
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Entity Type | Individual
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Provider Name | TABITHA JO SHEPHERD CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 1 SHIRCLIFF WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4748
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Country | US
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Telephone | 904-308-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 2664 COLD STREAM LN
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-8623
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Country | US
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Telephone | 405-413-4600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | RN9580294
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 155023
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11036894
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License Number State | FL
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