Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | ARNP9296168 | FL |
NPI | 1003258898 |
---|---|
Provider Name | Shannon Kathleen Burns |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2013 |
Last Update Date | 20/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00935000 | (05) | FL |