Provider Demographics
NPI:1598461261
Name:SHAW, LINDSAY J (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:J
Last Name:SHAW
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12057 JEWEL FISH LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7141
Mailing Address - Country:US
Mailing Address - Phone:561-707-6734
Mailing Address - Fax:
Practice Address - Street 1:4880 BIG ISLAND DR UNIT 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7490
Practice Address - Country:US
Practice Address - Phone:904-750-6863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily