Provider Demographics
NPI:1962482794
Name:FOLTZ, SHELLY ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:FOLTZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 ROYAL TERN RD S
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-7222
Mailing Address - Country:US
Mailing Address - Phone:904-501-8995
Mailing Address - Fax:
Practice Address - Street 1:418 ROYAL TERN RD S
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-7222
Practice Address - Country:US
Practice Address - Phone:904-501-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1796622367500000X
FLARNP1796622367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered