Healthcare Provider Details

I. General information

NPI: 1992166409
Provider Name (Legal Business Name): SHAWNA BLUME HANCOCK APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWNA JO KRISTEN BLUME ARNP, CPNP

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 S HIAWASSEE RD
ORLANDO FL
32835-5718
US

IV. Provider business mailing address

1507 S HIAWASSEE RD
ORLANDO FL
32835-5718
US

V. Phone/Fax

Practice location:
  • Phone: 407-253-1000
  • Fax: 407-253-1010
Mailing address:
  • Phone: 407-253-1000
  • Fax: 407-253-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP 9344428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: