Provider Demographics
NPI:1588446926
Name:MILLER, SHELBY (RN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:727-828-6370
Mailing Address - Fax:727-828-6371
Practice Address - Street 1:4949 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3800
Practice Address - Country:US
Practice Address - Phone:727-828-6370
Practice Address - Fax:727-828-6371
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9514746163W00000X
FLAPRN11029055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse