Basic Information
| Provider Information | |||||||||
| NPI: | 1821485707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIELDS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | ARNP, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 CLARK RD | ||||||||
| Address2: | STE H1 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342332366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419261600 | ||||||||
| FaxNumber: | 9419261166 | ||||||||
| Practice Location | |||||||||
| Address1: | 3920 BEE RIDGE RD | ||||||||
| Address2: | BLDG E, SUITE H | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342331207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419268855 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2015 | ||||||||
| LastUpdateDate: | 09/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9397054 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.