Provider Demographics
NPI:1841827789
Name:MOBILE PRACTITIONERS GROUP INC
Entity type:Organization
Organization Name:MOBILE PRACTITIONERS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITONER
Authorized Official - Phone:904-477-3138
Mailing Address - Street 1:3363 DIONE ST
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7582
Mailing Address - Country:US
Mailing Address - Phone:904-477-3138
Mailing Address - Fax:
Practice Address - Street 1:3363 DIONE ST
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7582
Practice Address - Country:US
Practice Address - Phone:904-477-3138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty