Healthcare Provider Details

I. General information

NPI: 1720459654
Provider Name (Legal Business Name): SHANNON SPREITZER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON SPREITZER ARNP

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6619 N WICKHAM RD
MELBOURNE FL
32940-2006
US

IV. Provider business mailing address

PO BOX 320871
COCOA BEACH FL
32932-0871
US

V. Phone/Fax

Practice location:
  • Phone: 321-259-9500
  • Fax: 321-253-1777
Mailing address:
  • Phone: 321-259-9500
  • Fax: 321-253-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9203475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: