Provider Demographics
NPI:1598510877
Name:PELTIER, SHANON MARIE (APRN)
Entity type:Individual
Prefix:
First Name:SHANON
Middle Name:MARIE
Last Name:PELTIER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 W SHELTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-5520
Mailing Address - Country:US
Mailing Address - Phone:813-777-9210
Mailing Address - Fax:
Practice Address - Street 1:2920 N ACADEMY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5359
Practice Address - Country:US
Practice Address - Phone:813-777-9210
Practice Address - Fax:800-319-3587
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999669363LF0000X, 363LP0808X
FL11032177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily