Individual
JADE SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
144 ENREDE LN, SAINT AUGUSTINE, FL 32095-7436
(530) 263-9295
Mailing address
144 ENREDE LN, SAINT AUGUSTINE, FL 32095-7436
(530) 263-9295
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT007582
PA
Other
Enumeration date
10/02/2020
Last updated
10/02/2020
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