Provider Demographics
NPI:1255979746
Name:TORRE, SHELBY (NP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:TORRE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:TORRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-821-8038
Mailing Address - Fax:813-974-0483
Practice Address - Street 1:615 N BONITA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3623
Practice Address - Country:US
Practice Address - Phone:850-769-1511
Practice Address - Fax:850-608-6434
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014455363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111525800Medicaid
FLOFI0JOtherBLUE CROSS BLUE SHIELD