Healthcare Provider Details

I. General information

NPI: 1023254299
Provider Name (Legal Business Name): SHANNON NICHOLE GROLEAU ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 UNIVERSITY BLVD S STE 300
JACKSONVILLE FL
32216-2752
US

IV. Provider business mailing address

3100 UNIVERSITY BLVD S STE 300
JACKSONVILLE FL
32216-2752
US

V. Phone/Fax

Practice location:
  • Phone: 904-274-8813
  • Fax: 904-503-4465
Mailing address:
  • Phone: 904-274-8813
  • Fax: 904-503-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License NumberAPRN9207713
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberARNP9207713
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9207713
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9207713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: