Provider Demographics
NPI:1336706779
Name:WELLS, SHAWN RENE (ARNP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:RENE
Last Name:WELLS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:RENE
Other - Last Name:WRUBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3266
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3266
Mailing Address - Country:US
Mailing Address - Phone:904-819-4602
Mailing Address - Fax:904-819-4426
Practice Address - Street 1:120 PALENCIA VILLAGE DR STE 107
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8553
Practice Address - Country:US
Practice Address - Phone:904-819-3200
Practice Address - Fax:904-819-4428
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9257150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner