Provider Demographics
NPI:1104554526
Name:SHIRLEY, SCOTT ALAN (APRN)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALAN
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10922 SCOTT MILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6512
Mailing Address - Country:US
Mailing Address - Phone:904-508-7049
Mailing Address - Fax:
Practice Address - Street 1:2349 VILLAGE SQUARE PKWY STE 112
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4319
Practice Address - Country:US
Practice Address - Phone:904-886-9686
Practice Address - Fax:904-253-6964
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021337363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care