Provider Demographics
NPI:1093815599
Name:ROGERS, SHIRL RENAE (ARNP, CWOCN)
Entity Type:Individual
Prefix:
First Name:SHIRL
Middle Name:RENAE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:ARNP, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8981 SW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7223
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:386-719-3617
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:WOUND CLINIC
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-719-3617
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564015163WW0000X
CA11458363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound Care
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health