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General NPI Number Information
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NPI Number | 1053247213
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Entity Type | Individual
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Provider Name | TARA ASHLEY SHAW DNAP, CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 449 W 23RD ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-4507
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Country | US
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Telephone | 850-767-8341
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Fax |
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Provider Business Mailing Address
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Address Line | 107 WHITE OAKS BLVD
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City | PANAMA CITY
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State | FL
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Zip | 32409-2371
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Country | US
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | APRN11048312
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License Number State | FL
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