Provider Demographics
NPI:1871744730
Name:WARD, SHANE CATHERINE (ARNP, CRNP)
Entity type:Individual
Prefix:MS
First Name:SHANE
Middle Name:CATHERINE
Last Name:WARD
Suffix:
Gender:F
Credentials:ARNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 OTTER POND RD
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32464-2809
Mailing Address - Country:US
Mailing Address - Phone:850-859-2611
Mailing Address - Fax:850-859-0168
Practice Address - Street 1:5992 BERRYHILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-1013
Practice Address - Country:US
Practice Address - Phone:850-626-9626
Practice Address - Fax:850-626-9606
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9181246363LF0000X
AL1-119971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily