Provider Demographics
NPI:1124263256
Name:HUGGINS, SHAVONDRA (WHNP-BC, FNP-C)
Entity type:Individual
Prefix:MS
First Name:SHAVONDRA
Middle Name:
Last Name:HUGGINS
Suffix:
Gender:F
Credentials:WHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9560 CROSSHILL BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-5827
Mailing Address - Country:US
Mailing Address - Phone:904-308-7792
Mailing Address - Fax:904-779-7335
Practice Address - Street 1:9560 CROSSHILL BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-5827
Practice Address - Country:US
Practice Address - Phone:904-308-7792
Practice Address - Fax:904-779-7335
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198927363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108960AMedicaid
FL0035385-00Medicaid
GA003108960AMedicaid