| Doctor Name: | JEANETTE SHABAZZ |
| NPI Number: | 1073916771 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | R885984 |
| Business Practice Address: | 3890 Bienville Blvd Ocean Springs, MS - 395645803 |
| Business Phone Number: | 2288726291 |
| Business Fax Number: | 2288753385 |
| Mailing Address: | 3616 Hospital St, PASCAGOULA |
| State: | MS |
| Postal Code: | 395814117 |
| Phone Number: | 2287691035 |
| Fax Number: | 2287692780 |
| NPI Enumeration Date: | 10/08/2014 |
| NPI Last Update Date: | 01/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R885984 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |