MEDICARE: SHELLEY ROSE PERRY 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	363L00000X	Nurse Practitioner	APRN1113732	FL

General Provider Information

NPI Number	:	1982830618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY ROSE PERRY APRN

Provider Business Mailing Address
First Line	:	327 NW HACKNEY TER
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-3173
Country	:	US
Telephone Number	:	305-342-7845
Fax Number	:

Provider Business Practice Location Address
First Line	:	4241 NW AMERICAN LN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4881
Country	:	US
Telephone Number	:	386-752-2246
Fax Number	:

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

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	07/18/2019

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