Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP9336257 | FL |
N | 363LN0000X | Nurse Practitioner - Neonatal | ARNP9336257 | FL |
NPI | 1124565031 |
---|---|
Provider Name | Dr. Shannon Eileen Katilus Makovic |
First Address | Gainesville, FL 32610-0296 |
Second Address | Gainesville, FL 32610-0296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2017 |
Last Update Date | 20/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020511800 | (05) | FL |