Provider Demographics
NPI:1093252058
Name:DESCHAMPS, SHAUNA M (APRN)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:M
Last Name:DESCHAMPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:M
Other - Last Name:DESCHAMPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:13540 17TH ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5244
Mailing Address - Country:US
Mailing Address - Phone:352-437-3107
Mailing Address - Fax:352-437-3120
Practice Address - Street 1:3100 E FLETCHER AVE STE 126
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-467-4770
Practice Address - Fax:813-467-4243
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9294904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020056900Medicaid
FLAPRN9294904OtherFLORIDA DEPARTMENT OF HEALTH
FLF1116401OtherAANP NATIONAL CERTIFICATION