Provider Demographics
NPI:1710557079
Name:SHIELDS, GLORIA K (MSN, FNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:K
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MSN, FNP-BC, RN
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Mailing Address - Street 1:1326 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-673-5000
Mailing Address - Fax:
Practice Address - Street 1:1342 PAPERMILL POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1903
Practice Address - Country:US
Practice Address - Phone:865-673-5000
Practice Address - Fax:865-588-5711
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNNA363L00000X
TN29515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ074096Medicaid