Provider Demographics
NPI:1487367785
Name:BARR, SHEA (APRN)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHEA
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6134 DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6744
Mailing Address - Country:US
Mailing Address - Phone:386-882-8777
Mailing Address - Fax:
Practice Address - Street 1:1270 PALM COAST PKWY NW
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4738
Practice Address - Country:US
Practice Address - Phone:386-225-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily