MEDICARE: SHANON MARIE PELTIER APRN

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	363LF0000X	Family Nurse Practitioner	0999669	CO
2	363LF0000X	Family Nurse Practitioner	11032177	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0999669	CO

General Provider Information

NPI Number	:	1598510877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANON MARIE PELTIER APRN

Provider Business Mailing Address
First Line	:	2811 W SHELTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-5520
Country	:	US
Telephone Number	:	813-777-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 N ACADEMY BLVD STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5359
Country	:	US
Telephone Number	:	813-777-9210
Fax Number	:	800-319-3587

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

Provider Enumeration Date	:	04/20/2024
Last Update Date	:	04/23/2025

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