Shawn Mullinax Van Dyne, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9176799 Issued in FL

Practice address

113 Lielmanis Ave
Hurlburt Field, FL 32544-5613

Phone

(850) 881-5349

NPI assigned

Jul 4, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1530662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704585600000",
    "number": "1255827077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LIELMANIS AVE",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "325445613",
            "telephone_number": "850-881-5349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LIELMANIS AVE",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "325445613",
            "telephone_number": "850-881-5349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYNE",
        "first_name": "SHAWN",
        "middle_name": "MULLINAX",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-04",
        "last_updated": "2024-01-07",
        "certification_date": "2024-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9176799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• VI N Tran, MD
• Joanna Faith Trease, LCSW
• Michelle Patrizia Trivino, LCSW
• Emily Grace Turner, LCSW
• Chelsea Tyson, MD
• Alison Jean Vandenberghe, MS, RD, LD
• See Sally Vang, O.D.
• John Adam Vann, PA-C
• Joseph Daniel Villacis, M.D.
• Thuy Nga Vo, PHARMD

• Family Nurse Practitioner in Hurlburt Field, FL
• Providers in Hurlburt Field, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.