Provider Demographics
NPI:1972225704
Name:DAVIE, SHANNON NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NICOLE
Last Name:DAVIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:HIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5305
Mailing Address - Fax:352-616-0926
Practice Address - Street 1:15211 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6072
Practice Address - Country:US
Practice Address - Phone:352-345-4565
Practice Address - Fax:352-596-6051
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9494102363LF0000X
FLAPRN11021241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily