MEDICARE: MRS. SUSAN W SHIELDS 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	363LP0200X	Pediatric Nurse Practitioner	APRN1402992	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	:	1871568105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN W SHIELDS ARNP

Provider Business Mailing Address
First Line	:	2995 DREW ST FL 2
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	727-315-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 SIMMONS LOOP
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-9498
Country	:	US
Telephone Number	:	813-302-8522
Fax Number	:	813-605-6167

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	12/31/2024

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