Provider Demographics
NPI:1891864187
Name:SHAW, LUCINDA (CNM MSN)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:CNM MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11175 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5615
Mailing Address - Country:US
Mailing Address - Phone:352-686-8888
Mailing Address - Fax:352-684-6888
Practice Address - Street 1:11175 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5615
Practice Address - Country:US
Practice Address - Phone:352-686-8888
Practice Address - Fax:352-684-6888
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9269687363LX0001X
NJ25ME00026801367A00000X
FLARNP9269687367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308772700Medicaid
FLP76694Medicare UPIN