Provider Demographics
NPI:1225402118
Name:SHAW, CARMENCITA E (DNP)
Entity Type:Individual
Prefix:DR
First Name:CARMENCITA
Middle Name:E
Last Name:SHAW
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
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Mailing Address - Street 1:947 BAREFOOT BLVD
Mailing Address - Street 2:
Mailing Address - City:BAREFOOT BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32976-7101
Mailing Address - Country:US
Mailing Address - Phone:321-593-6999
Mailing Address - Fax:321-327-2262
Practice Address - Street 1:947 BAREFOOT BLVD
Practice Address - Street 2:
Practice Address - City:BAREFOOT BAY
Practice Address - State:FL
Practice Address - Zip Code:32976-7101
Practice Address - Country:US
Practice Address - Phone:321-593-6999
Practice Address - Fax:321-327-2262
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9432845207Q00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine