Healthcare Provider Details

I. General information

NPI: 1255245387
Provider Name (Legal Business Name): SHANNON LEEANN AGUILAR MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON POLK RN

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22492 MIDDLETOWN DR
BOCA RATON FL
33428-4708
US

IV. Provider business mailing address

22492 MIDDLETOWN DR
BOCA RATON FL
33428-4708
US

V. Phone/Fax

Practice location:
  • Phone: 806-477-2327
  • Fax:
Mailing address:
  • Phone: 806-477-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11051211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: