Healthcare Provider Details

I. General information

NPI: 1659177376
Provider Name (Legal Business Name): SHANNON ROSE NELSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22524 MIDDLETOWN DR
BOCA RATON FL
33428-4709
US

IV. Provider business mailing address

22524 MIDDLETOWN DR
BOCA RATON FL
33428-4709
US

V. Phone/Fax

Practice location:
  • Phone: 561-305-6126
  • Fax:
Mailing address:
  • Phone: 561-305-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11034493
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11034493
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAPRN11034493
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11034493
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11034493
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11034493
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11034493
License Number StateFL
# 8
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: