Provider Demographics
NPI:1063123792
Name:VANFLEET, SHELBY (APRN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:VANFLEET
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 1:9730 CHERRY CHAPEL LOOP
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-6908
Mailing Address - Country:US
Mailing Address - Phone:731-614-9322
Mailing Address - Fax:
Practice Address - Street 1:1920 PICKWICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-5309
Practice Address - Country:US
Practice Address - Phone:731-925-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily