Provider Demographics
NPI:1053497420
Name:SHREVE, VIRGINIA SUE (APRN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SUE
Last Name:SHREVE
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:352-335-8888
Mailing Address - Fax:352-335-9427
Practice Address - Street 1:4627 NW 53RD AVENUE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4627
Practice Address - Country:US
Practice Address - Phone:352-335-8888
Practice Address - Fax:352-335-9427
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2153082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003778800Medicaid
FL302096700Medicaid