Provider Demographics
NPI:1760524060
Name:SHIVERS, LAUREN CLAXTON (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:CLAXTON
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:CLAXTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:8351 WESTPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244
Mailing Address - Country:US
Mailing Address - Phone:904-317-8811
Mailing Address - Fax:904-317-4949
Practice Address - Street 1:8351 WESTPORT ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244
Practice Address - Country:US
Practice Address - Phone:904-317-8811
Practice Address - Fax:904-317-4949
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9190912363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308287300Medicaid