MEDICARE: MRS. HOLLY K SHIVELY 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	363LW0102X	Women's Health Nurse Practitioner	ARNP9170049	FL
2	363LW0102X	Women's Health Nurse Practitioner	37506	TN
3	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP9170049	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	:	1508136359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY K SHIVELY ARNP

Provider Business Mailing Address
First Line	:	3217 CAPITAL MEDICAL BLVD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3217 CAPITAL MEDICAL BLVD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4413
Country	:	US
Telephone Number	:	850-320-7693
Fax Number	:

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	04/10/2026

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