Provider Demographics
NPI:1770717803
Name:SHELDON, JANE MARIE (RN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:SHELDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 RENATTA DR APT 3
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1756
Mailing Address - Country:US
Mailing Address - Phone:727-543-4845
Mailing Address - Fax:
Practice Address - Street 1:8422 SUN DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3339
Practice Address - Country:US
Practice Address - Phone:727-237-1570
Practice Address - Fax:727-213-6246
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1553452163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690774196OtherHCBS MEDICAID