Provider Demographics
NPI:1821092511
Name:SHIMP, WILLIAM M (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:SHIMP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 KING ST
Mailing Address - Street 2:STE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4735
Mailing Address - Country:US
Mailing Address - Phone:904-384-3343
Mailing Address - Fax:904-400-6671
Practice Address - Street 1:300 HEALTH PARK BLVD STE 5008
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3705
Practice Address - Country:US
Practice Address - Phone:904-494-2394
Practice Address - Fax:904-400-6676
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101052363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970014848OtherMEDICARE RAILROAD
FL290815800Medicaid