Provider Demographics
NPI:1093435745
Name:SHAW, RACHEL (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 GATE PKWY N APT 912
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4433
Mailing Address - Country:US
Mailing Address - Phone:410-790-4976
Mailing Address - Fax:
Practice Address - Street 1:10075 GATE PKWY N APT 912
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4433
Practice Address - Country:US
Practice Address - Phone:410-790-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily