Healthcare Provider Details

I. General information

NPI: 1245248871
Provider Name (Legal Business Name): SHAWN MARIE DAGUE ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWN MARIE MIODEK

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SYKES CREEK PKWY STE 300
MERRITT ISLAND FL
32953-3488
US

IV. Provider business mailing address

150 N SYKES CREEK PKWY STE 300
MERRITT ISLAND FL
32953-3488
US

V. Phone/Fax

Practice location:
  • Phone: 321-459-1192
  • Fax: 321-459-2304
Mailing address:
  • Phone: 321-459-1192
  • Fax: 321-459-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9291971
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9291971
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9291971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: