Healthcare Provider Details

I. General information

NPI: 1528091998
Provider Name (Legal Business Name): SHANNEN LEA VIXLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13691 METRO PKWY STE 310
FORT MYERS FL
33912-4322
US

IV. Provider business mailing address

PO BOX 984
ESTERO FL
33929-0984
US

V. Phone/Fax

Practice location:
  • Phone: 239-768-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9198349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: