Basic Information
| Provider Information | |||||||||
| NPI: | 1124101597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYATT | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | REESE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ANP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9160 FORUM CORPORATE PKWY STE 350 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339057808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397853200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 551 BREVARD RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288062316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282127021 | ||||||||
| FaxNumber: | 8282328218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2006 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 0050-00698 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | 5000698 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 7003961 | 05 | NC | MEDICAID |