1881898963 NPI number — MRS. SHELBY DARLENE NORRIS MSN ARNP

Table of content: MRS. SHELBY DARLENE NORRIS MSN ARNP (NPI 1881898963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881898963 NPI number — MRS. SHELBY DARLENE NORRIS MSN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORRIS
Provider First Name:
SHELBY
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881898963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5503 S CONGRESS AVE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
ATLANTIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33462-6625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-964-7511
Provider Business Mailing Address Fax Number:
561-964-7544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 45TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-964-7511
Provider Business Practice Location Address Fax Number:
561-964-7544
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP694812 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000278801 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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