Healthcare Provider Details

I. General information

NPI: 1548076045
Provider Name (Legal Business Name): SHEA MARKS GOLONKA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GOODLETTE RD
NAPLES FL
34102-5451
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-0656
  • Fax: 239-261-0060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11035641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: