Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN11004710 | FL |
NPI | 1033758081 |
---|---|
Provider Name | Shannon Boston |
First Address | Groveland, FL 34736-8047 |
Second Address | Clermont, FL 34715-9025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2019 |
Last Update Date | 21/12/2019 |