MEDICARE: MS. SHELIA Y ROBERTS 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	363LA2200X	Adult Health Nurse Practitioner	ARNP683592	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	K9539	OTHER	FL	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTAN E6480V	OTHER	FL	LINKED TO GROUP PTAN IE881A EFFECTIVE 07/01/15
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750358073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELIA Y ROBERTS ARNP

Provider Business Mailing Address
First Line	:	PO BOX 1642
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-1642
Country	:	US
Telephone Number	:	386-755-1655
Fax Number	:	386-755-2330

Provider Business Practice Location Address
First Line	:	289 SW STONEGATE TER
Second Line	:	SUITE 103
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3457
Country	:	US
Telephone Number	:	386-755-1655
Fax Number	:	386-755-2330

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

Provider Enumeration Date	:	03/06/2006
Last Update Date	:	03/09/2016

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