Provider Demographics
NPI:1780022590
Name:PAPILLON ANDERSON, SHELA (ANP-BC, MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:SHELA
Middle Name:
Last Name:PAPILLON ANDERSON
Suffix:
Gender:F
Credentials:ANP-BC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 SW DALTON CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5813
Mailing Address - Country:US
Mailing Address - Phone:772-626-5937
Mailing Address - Fax:
Practice Address - Street 1:800 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1828
Practice Address - Country:US
Practice Address - Phone:954-606-5217
Practice Address - Fax:888-503-1690
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10007556363LA2200X
GAGAA-NP000009363LA2200X
VA0024189534363LA2200X
FLARNP 9236018363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9236018OtherSTATE LICENSE