Provider Demographics
NPI:1669543526
Name:DORIA, RISA SHULER (MSN, ARNP, CS)
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:SHULER
Last Name:DORIA
Suffix:
Gender:F
Credentials:MSN, ARNP, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19249
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-9249
Mailing Address - Country:US
Mailing Address - Phone:904-743-1883
Mailing Address - Fax:904-743-5109
Practice Address - Street 1:11820 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6670
Practice Address - Country:US
Practice Address - Phone:904-642-9100
Practice Address - Fax:904-642-9108
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1091102363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304944OtherUNITED BEHAVIORAL HEALTH
FL761639200Medicaid
FLS18000Medicare UPIN
FL304944OtherUNITED BEHAVIORAL HEALTH