Healthcare Provider Details

I. General information

NPI: 1437081254
Provider Name (Legal Business Name): SHANNON S BARRIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 MICHIGAN AVE
FORT MYERS FL
33916-2205
US

IV. Provider business mailing address

83 PONDELLA RD
NORTH FORT MYERS FL
33903-4411
US

V. Phone/Fax

Practice location:
  • Phone: 239-332-9501
  • Fax:
Mailing address:
  • Phone: 239-986-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN9280647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: