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General NPI Number Information
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NPI Number | 1225402118
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Entity Type | Individual
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Provider Name | CARMENCITA E SHAW DNP
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Gender | Female
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 947 BAREFOOT BLVD
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City | BAREFOOT BAY
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State | FL
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Zip | 32976-7101
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Country | US
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Telephone | 321-593-6999
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Fax | 321-327-2262
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Provider Business Mailing Address
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Address Line | 947 BAREFOOT BLVD
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City | BAREFOOT BAY
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State | FL
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Zip | 32976-7101
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Country | US
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Telephone | 321-593-6999
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Fax | 321-327-2262
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN9432845
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN9432845
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License Number State | FL
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