Provider Demographics
NPI:1992334650
Name:SHANKLE, ERNESTA (APRN, FNP-C , PHD)
Entity type:Individual
Prefix:
First Name:ERNESTA
Middle Name:
Last Name:SHANKLE
Suffix:
Gender:F
Credentials:APRN, FNP-C , PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2872
Mailing Address - Country:US
Mailing Address - Phone:813-850-0844
Mailing Address - Fax:
Practice Address - Street 1:1000 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2872
Practice Address - Country:US
Practice Address - Phone:813-850-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily