Provider Demographics
NPI:1881946960
Name:PHILIP, SHIRLY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLY
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 E HIBISCUS ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2456
Mailing Address - Country:US
Mailing Address - Phone:954-821-6874
Mailing Address - Fax:954-486-5335
Practice Address - Street 1:3843 E HIBISCUS ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-2456
Practice Address - Country:US
Practice Address - Phone:954-821-6874
Practice Address - Fax:954-486-5335
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9216553163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator