Provider Demographics
NPI:1225093313
Name:SHOOK, CAROLYN GRACE (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:GRACE
Last Name:SHOOK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:GRACE
Other - Last Name:CORNETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 862851
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2851
Mailing Address - Country:US
Mailing Address - Phone:954-847-4273
Mailing Address - Fax:954-847-4245
Practice Address - Street 1:200 NW 7 AVENUE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311
Practice Address - Country:US
Practice Address - Phone:954-759-6600
Practice Address - Fax:954-759-6665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1597042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8171YMedicare ID - Type Unspecified
S83766Medicare UPIN