Healthcare Provider Details

I. General information

NPI: 1306128533
Provider Name (Legal Business Name): SHUNTA JACKSON-SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 S FEDERAL HWY STE 100
BOYNTON BEACH FL
33435-7751
US

IV. Provider business mailing address

2923 S FEDERAL HWY STE 100
BOYNTON BEACH FL
33435-7751
US

V. Phone/Fax

Practice location:
  • Phone: 561-752-0100
  • Fax: 561-740-3001
Mailing address:
  • Phone: 561-752-0100
  • Fax: 561-740-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9196308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: