MEDICARE: SHANNON TRACY GHATTAS

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	11004145	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1821649211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON TRACY GHATTAS

Provider Business Mailing Address
First Line	:	580 VILLAGE BLVD STE 270
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1951
Country	:	US
Telephone Number	:	561-247-5658
Fax Number	:	561-725-7937

Provider Business Practice Location Address
First Line	:	580 VILLAGE BLVD STE 270
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1951
Country	:	US
Telephone Number	:	561-247-5658
Fax Number	:	561-725-7937

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

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	01/07/2026

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Directions to “ SHANNON TRACY GHATTAS ” Practice Location

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