Provider Demographics
NPI:1851575419
Name:GERLACH, SHELLY LYNN (RN, MSN, FNP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:GERLACH
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11180 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-4648
Mailing Address - Country:US
Mailing Address - Phone:813-915-5459
Mailing Address - Fax:
Practice Address - Street 1:11180 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-4648
Practice Address - Country:US
Practice Address - Phone:813-915-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9301254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01303905OtherR&R MEDICARE - UCC
FLDA256Y - FMCMedicare PIN
FLDA256X - UCCMedicare PIN