Healthcare Provider Details

I. General information

NPI: 1205421427
Provider Name (Legal Business Name): SHANNON SWIDERSKI MSN, CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON MANNING

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19283 STATE HIGHWAY 59
SUMMERDALE AL
36580-3005
US

IV. Provider business mailing address

PO BOX 280
GULF BREEZE FL
32562-0280
US

V. Phone/Fax

Practice location:
  • Phone: 251-523-5437
  • Fax: 866-628-7517
Mailing address:
  • Phone: 850-932-5055
  • Fax: 850-932-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11012182
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137654
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: