Individual provider Active NPI

Tabitha Jo Shepherd, CRNA

  • Certified Registered Nurse Anesthetist
  • Jacksonville, FL
National Provider Identifier
1023833555
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN11036894 Issued in FL
Practice address
1 Shircliff Way
Jacksonville, FL 32204-4748
Phone
(904) 308-7300
NPI assigned
Nov 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Intensive Care Registered Nurse 163WN0002X RN9580294 FL
Certified Registered Nurse Anesthetist 367500000X 155023 FL
Certified Registered Nurse Anesthetist 367500000X APRN11036894 FL Primary

Addresses

Primary practice location

1 Shircliff Way
Jacksonville, FL 32204-4748

Mailing address

2664 Cold Stream LN
Green Cove Springs, FL 32043-8623
Phone (405) 413-4600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250206003150 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 7012447998 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Florida Anesthesia Consultants IncGroup PAC ID 7416869565, 110 clinicians

Practice addresses (Care Compare)

1 Shircliff Way
Jacksonville, FL 32204-4748
Phone (954) 939-5000

Hospital & facility affiliations

  • Ascension St Vincent'S Clay County Hospital, Middleburg, FL, CCN 100321
  • Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040
  • Ascension St Vincent'S Southside Hospital, Jacksonville, FL, CCN 100307

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN9580294FLMDNeonatal Intensive Care Registered Nurse
155023FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered CurrentSince May 1, 2025 Accepting new patients
North Florida Anesthesia Consultants Inc Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2025 Accepting new patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
North Florida Anesthesia Consultants, Inc. CurrentSince Jan 1, 2025 Accepting new patients
North Florida Anesthesia Consultants Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
Sheridan Healthcorp, Inc. CurrentSince May 1, 2025 Accepting new patients

Locations

201 E Sample Rd
Deerfield Beach, FL 33064
Phone (954) 786-6400

1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414

1670 St Vincents Way
Middleburg, FL 32068
Phone (904) 308-3960

401 NW 42nd Ave
Plantation, FL 33317
Phone (954) 513-6434

1613 NW 136th Ave
Ste 200
Sunrise, FL 33323
Phone (954) 838-2502

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1023833555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2664 COLD STREAM LN",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320438623",
            "telephone_number": "405-413-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SHIRCLIFF WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044748",
            "telephone_number": "904-308-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "TABITHA",
        "middle_name": "JO",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-19",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WN0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal Intensive Care",
            "state": "FL",
            "license": "RN9580294",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "155023",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "APRN11036894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.