Provider Demographics
NPI:1992259477
Name:SHEPARD, DAWN MICHELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MICHELLE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100187
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0187
Mailing Address - Country:US
Mailing Address - Phone:352-265-2550
Mailing Address - Fax:352-627-4785
Practice Address - Street 1:16939 SW 134TH AVE
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618-5413
Practice Address - Country:US
Practice Address - Phone:352-265-2550
Practice Address - Fax:352-627-4785
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3312562363LF0000X, 363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIX607ZMedicare PIN