Healthcare Provider Details

I. General information

NPI: 1689620247
Provider Name (Legal Business Name): SHANNON GROW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 SW 60TH AVE
OCALA FL
34476-6408
US

IV. Provider business mailing address

5258 SE 44TH CIR
OCALA FL
34480-4917
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-6741
  • Fax:
Mailing address:
  • Phone: 352-624-2767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11004142
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2151012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: