Provider Demographics
NPI:1043651847
Name:SHI, KATLIN P (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KATLIN
Middle Name:P
Last Name:SHI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:KATLIN
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 SHIRCLIFF WAY
Mailing Address - Street 2:ST. VINCENT'S RIVERSIDE EMERGENCY ROOM
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4748
Mailing Address - Country:US
Mailing Address - Phone:904-308-7300
Mailing Address - Fax:
Practice Address - Street 1:1 SHIRCLIFF WAY
Practice Address - Street 2:ST. VINCENT'S RIVERSIDE EMERGENCY ROOM
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4748
Practice Address - Country:US
Practice Address - Phone:904-308-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA - 9109389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant