MEDICARE: NIKA SHANNON STEWART CRNA

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	367500000X	Certified Registered Nurse Anesthetist	FLARNP2856672	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	:	1932244357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKA SHANNON STEWART CRNA

Provider Business Mailing Address
First Line	:	801 E 6TH ST STE 202
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3652
Country	:	US
Telephone Number	:	850-785-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 E 6TH ST STE 202
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3652
Country	:	US
Telephone Number	:	850-785-3185
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/21/2014

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