Healthcare Provider Details

I. General information

NPI: 1659904449
Provider Name (Legal Business Name): SHANNON HASSETT HARVILLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 LAWTON RD STE 100
ORLANDO FL
32803-3519
US

IV. Provider business mailing address

3113 LAWTON RD STE 100
ORLANDO FL
32803-3519
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-3241
  • Fax: 407-896-9863
Mailing address:
  • Phone: 407-894-3241
  • Fax: 407-896-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number9435702
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11016527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: