Provider Demographics
NPI:1821026428
Name:CAREY, SHANA L (ARNP)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:L
Last Name:CAREY
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 1:205 BALEARICS DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-1885
Mailing Address - Country:US
Mailing Address - Phone:615-513-0002
Mailing Address - Fax:
Practice Address - Street 1:2021 KINGSLEY AVE STE 109
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5128
Practice Address - Country:US
Practice Address - Phone:904-295-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9289411163W00000X, 363LA2200X, 363L00000X
FLARNP9289411363LF0000X
TNAPN0000013829363L00000X
TNRN0000163885163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15715UOtherREGENCE BLUE SHIELD PIN
FL9646340Medicaid
FL8856399OtherMEDICARE UPIN
FLQ53154OtherMEDICARE UPIN