MEDICARE: LINDSAY J SHAW FNP-BC

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	363LF0000X	Family Nurse Practitioner	11022329	FL

General Provider Information

NPI Number	:	1598461261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY J SHAW FNP-BC

Provider Business Mailing Address
First Line	:	12057 JEWEL FISH LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7141
Country	:	US
Telephone Number	:	561-707-6734
Fax Number	:

Provider Business Practice Location Address
First Line	:	4880 BIG ISLAND DR UNIT 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7490
Country	:	US
Telephone Number	:	904-750-6863
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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