Provider Demographics
NPI:1629743216
Name:SHIFLETT, SCARLET RENEE (NP-C)
Entity Type:Individual
Prefix:
First Name:SCARLET
Middle Name:RENEE
Last Name:SHIFLETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 HOOKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:GA
Mailing Address - Zip Code:31764-2436
Mailing Address - Country:US
Mailing Address - Phone:229-881-9118
Mailing Address - Fax:
Practice Address - Street 1:1626 JEURGENS CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2219
Practice Address - Country:US
Practice Address - Phone:770-279-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF07211218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily