Provider Demographics
NPI:1679236848
Name:HALL, SHELLY-ANN ANNMARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY-ANN
Middle Name:ANNMARIE
Last Name:HALL
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 1:6309 SILK OAK CIR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3545
Mailing Address - Country:US
Mailing Address - Phone:954-702-2208
Mailing Address - Fax:
Practice Address - Street 1:6309 SILK OAK CIR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3545
Practice Address - Country:US
Practice Address - Phone:954-702-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015525363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty