Provider Demographics
NPI:1780163782
Name:WILKS, SHEVAN SHENIER (APRN)
Entity type:Individual
Prefix:
First Name:SHEVAN
Middle Name:SHENIER
Last Name:WILKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-3509
Mailing Address - Country:US
Mailing Address - Phone:954-867-8861
Mailing Address - Fax:
Practice Address - Street 1:2901 CORAL HILLS DR STE 330
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4165
Practice Address - Country:US
Practice Address - Phone:954-231-8700
Practice Address - Fax:954-231-8707
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9369005363LA2200X
FLARNP9369005363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health