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General NPI Number Information
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NPI Number | 1982830618
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Entity Type | Individual
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Provider Name | SHELLEY ROSE PERRY APRN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 4241 NW AMERICAN LN
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City | LAKE CITY
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State | FL
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Zip | 32055-4881
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Country | US
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Telephone | 386-752-2246
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Fax |
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Provider Business Mailing Address
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Address Line | 327 NW HACKNEY TER
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City | LAKE CITY
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State | FL
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Zip | 32055-3173
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Country | US
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Telephone | 305-342-7845
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN1113732
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License Number State | FL
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