Individual
MRS. SHAVANNA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP- BC
Contact information
Practice address
1620 CORSAIR LN STE 201, MIDDLEBURG, FL 32068-8558
(904) 787-8850
Mailing address
590 CHANCELLOR DR W, JACKSONVILLE, FL 32225-8143
(904) 420-9724
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9394466
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11033411
FL
Other
Enumeration date
06/22/2024
Last updated
01/23/2025
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