Provider Demographics
NPI:1659643997
Name:HAVENS, SHELBY ELAINE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:ELAINE
Last Name:HAVENS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 NE 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2639
Mailing Address - Country:US
Mailing Address - Phone:352-491-4444
Mailing Address - Fax:352-491-4410
Practice Address - Street 1:3333 NE 39TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2639
Practice Address - Country:US
Practice Address - Phone:352-491-4444
Practice Address - Fax:352-491-4410
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1785392363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care