Healthcare Provider Details

I. General information

NPI: 1639587728
Provider Name (Legal Business Name): DEBBIE C. SHENEMAN NP-C INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 14TH ST W
BRADENTON FL
34205-6646
US

IV. Provider business mailing address

926 14TH ST W
BRADENTON FL
34205-6646
US

V. Phone/Fax

Practice location:
  • Phone: 813-759-3385
  • Fax: 813-702-9477
Mailing address:
  • Phone: 813-759-3385
  • Fax: 813-702-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2221632
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE C. SHENEMAN
Title or Position: OWNER
Credential: NP-C
Phone: 941-920-2842