Healthcare Provider Details

I. General information

NPI: 1982308482
Provider Name (Legal Business Name): SHANNON MICHELE REYNOLDS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 SE 3RD CT STE 100
OCALA FL
34471-0480
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-1777
  • Fax: 352-622-1929
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11025467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: