Provider Demographics
NPI:1740360122
Name:BUCKLEY, SHELLY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:LYNN
Other - Last Name:TOWNSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:6600 UNIVERSITY PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9048
Mailing Address - Country:US
Mailing Address - Phone:941-361-1100
Mailing Address - Fax:941-361-1103
Practice Address - Street 1:6600 UNIVERSITY PKWY STE 301
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-9048
Practice Address - Country:US
Practice Address - Phone:941-361-1100
Practice Address - Fax:941-361-1103
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9488373363LF0000X
IN71002224A364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health