MEDICARE: SHELLY A TAHAL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	APN3267092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194747212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY A TAHAL ARNP

Provider Business Mailing Address
First Line	:	1480 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6040
Country	:	US
Telephone Number	:	954-840-0530
Fax Number	:	954-840-3570

Provider Business Practice Location Address
First Line	:	1480 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6040
Country	:	US
Telephone Number	:	954-840-0530
Fax Number	:	954-840-3570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/20/2025

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