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NPI Code Detail

MEDICARE: SHANNON JAMERSON ARNP

MEDICARE: SHANNON JAMERSON ARNP
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
1363LF0000XFamily Nurse Practitioner53-75450-012KS
2363LF0000XFamily Nurse Practitioner109050OK
3363LF0000XFamily Nurse PractitionerAPRN11006157FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578841169
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON JAMERSON ARNP
Provider Business Mailing Address
First Line : 500 VONDERBURG DR STE 311W
Second Line :
City : BRANDON
State : FL
Zip : 33511-5978
Country : US
Telephone Number : 813-654-2445
Fax Number : 813-654-9885
Provider Business Practice Location Address
First Line : 10902 MCKINLEY DR
Second Line :
City : TAMPA
State : FL
Zip : 33612-6471
Country : US
Telephone Number : 813-745-6899
Fax Number : 813-745-6599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2011
Last Update Date : 08/15/2025

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