Provider Demographics
NPI:1093722647
Name:FABRIZIO, SHIRLEY LYNN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:LYNN
Last Name:FABRIZIO
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Gender:F
Credentials:ARNP
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Mailing Address - Street 1:7015 A C SKINNER PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:1375 ROBERTS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3210
Practice Address - Country:US
Practice Address - Phone:904-997-3800
Practice Address - Fax:904-997-3899
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-05-03
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Provider Licenses
StateLicense IDTaxonomies
FL2212592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3089061-00Medicaid
FLAI194ZMedicare PIN