Provider Demographics
NPI:1225610637
Name:MORGAN, SHELLEY CAMILLE (APRN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:CAMILLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 ISABELLA LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1928
Mailing Address - Country:US
Mailing Address - Phone:904-536-8334
Mailing Address - Fax:
Practice Address - Street 1:7708 ISABELLA LN
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1928
Practice Address - Country:US
Practice Address - Phone:904-536-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily