Provider Demographics
NPI:1992166409
Name:HANCOCK, SHAWNA BLUME (APRN, CPNP)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:BLUME
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:JO KRISTEN
Other - Last Name:BLUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, CPNP
Mailing Address - Street 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5718
Mailing Address - Country:US
Mailing Address - Phone:407-253-1000
Mailing Address - Fax:407-253-1010
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5718
Practice Address - Country:US
Practice Address - Phone:407-253-1000
Practice Address - Fax:407-253-1010
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9344428363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics