Provider Demographics
NPI:1801966304
Name:ALDRICH, SHIRLEY ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ELIZABETH
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:ELIZABETH
Other - Last Name:DYER SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:745 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5702
Practice Address - Country:US
Practice Address - Phone:904-213-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3183912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3080382-00Medicaid
FLU8419ZMedicare PIN
FLP00369543Medicare PIN