MICAELA RAE SHANNON NPI 1023654647

NPI Information

NPI: 1023654647
Provider Name: MICAELA RAE SHANNON
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
7016 NORMANDY BLVD
JACKSONVILLE, FL
ZIP 32205
Phone: (904) 783-2405
Get Directions

Micaela Rae Shannon is a family nurse practitioner in Jacksonville, FL with 3 years of experience. Micaela Rae Shannon NPI is 1023654647. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

7016 NORMANDY BLVD
JACKSONVILLE, FL
ZIP 32205-206
Phone: (904) 783-2405
Fax: (904) 420-6101

The NPI 1023654647 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/19/2019 and was last updated on 3/4/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP2300X	Nurse Practitioner	Primary Care	APRN11015772	FLORIDA	No
2	163WE0003X	Registered Nurse	Emergency	RN9469517	FLORIDA	No
3	363LF0000X	Nurse Practitioner	Family	APRN11015772	FLORIDA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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