Healthcare Provider Details

I. General information

NPI: 1366745234
Provider Name (Legal Business Name): SHONNA SAMANTHA BATES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTHCARE WAY UNIT 200
NORTH VENICE FL
34275-3670
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-261-0145
  • Fax: 941-261-0150
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA 11322-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9460383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: