MEDICARE: SHALOM BARILE APRN

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	11009461	FL
2	363LP2300X	Primary Care Nurse Practitioner	APRN11009461	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	:	1649877200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALOM BARILE APRN

Provider Business Mailing Address
First Line	:	6520 FORT CAROLINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2044
Country	:	US
Telephone Number	:	904-745-3618
Fax Number	:	904-722-4271

Provider Business Practice Location Address
First Line	:	1372 PEACHTREE ST NE
Second Line	:	STE 100
City	:	ATLANTA
State	:	GA
Zip	:	30309-3203
Country	:	US
Telephone Number	:	470-964-1700
Fax Number	:	678-288-5639

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

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	07/03/2025

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