MEDICARE: SHANICE TATIANA FORBES DMSC, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9120066	FL

General Provider Information

NPI Number	:	1306631106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANICE TATIANA FORBES DMSC, PA-C

Provider Business Mailing Address
First Line	:	2349 E HWY 50
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6053
Country	:	US
Telephone Number	:	352-348-9484
Fax Number	:	352-717-3761

Provider Business Practice Location Address
First Line	:	2349 E HWY 50
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6053
Country	:	US
Telephone Number	:	352-717-3760
Fax Number	:	352-717-3761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2025
Last Update Date	:	12/17/2025

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