Healthcare Provider Details

I. General information

NPI: 1306631106
Provider Name (Legal Business Name): SHANICE TATIANA FORBES DMSC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 E HWY 50
CLERMONT FL
34711-6053
US

IV. Provider business mailing address

2349 E HWY 50
CLERMONT FL
34711-6053
US

V. Phone/Fax

Practice location:
  • Phone: 352-717-3760
  • Fax: 352-717-3761
Mailing address:
  • Phone: 352-348-9484
  • Fax: 352-717-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: