Healthcare Provider Details

I. General information

NPI: 1194650085
Provider Name (Legal Business Name): SHANNON IRENE CASEBEER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 RUSTY RAIL RD
JACKSONVILLE FL
32225-5527
US

IV. Provider business mailing address

1637 RUSTY RAIL RD
JACKSONVILLE FL
32225-5527
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-0133
  • Fax:
Mailing address:
  • Phone: 904-383-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2026001563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: