Provider Demographics
NPI:1194814822
Name:ALLEN, SHEILA (ARNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 STOUT RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5761
Mailing Address - Country:US
Mailing Address - Phone:850-697-2019
Mailing Address - Fax:
Practice Address - Street 1:4431 STOUT RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5761
Practice Address - Country:US
Practice Address - Phone:850-697-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2993892363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD121YOtherMEDICARE
FL003148700Medicaid
FLAD121ZMedicare PIN
FL003148700Medicaid