Provider Demographics
NPI:1972573236
Name:SHIFFER, SCOTT WAYNE (FNP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WAYNE
Last Name:SHIFFER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 RILEY RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-8009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7119 LANGLEY ST
Practice Address - Street 2:NAVAL BRANCH HEALTH CLINIC
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-6105
Practice Address - Country:US
Practice Address - Phone:850-623-7173
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily