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NPI Code Detail

MEDICARE: MS. SHELBY A PETCOFF MSN, APRN, FNP-C

MEDICARE: MS. SHELBY A PETCOFF MSN, APRN, FNP-C
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
1363LP2300XPrimary Care Nurse PractitionerAPRN.CNP.0031563OH

General Provider Information

NPI Number : 1316675572
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHELBY A PETCOFF MSN, APRN, FNP-C
Provider Business Mailing Address
First Line : 1601 BRIGHAM DR STE 200
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-7117
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1601 BRIGHAM DR STE 200
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-7117
Country : US
Telephone Number : 567-585-0380
Fax Number : 567-585-0381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2022
Last Update Date : 02/18/2026

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