Provider Demographics
NPI:1285176453
Name:DILLMAN, SHONNA LYN (ARNP)
Entity type:Individual
Prefix:
First Name:SHONNA
Middle Name:LYN
Last Name:DILLMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHONNA
Other - Middle Name:LYN
Other - Last Name:DILLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:3424 HIGHWAY 252 EAST
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537
Mailing Address - Country:US
Mailing Address - Phone:912-496-6905
Mailing Address - Fax:
Practice Address - Street 1:86567 MEADOWWOOD DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6429
Practice Address - Country:US
Practice Address - Phone:904-424-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9248227363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health