Healthcare Provider Details

I. General information

NPI: 1730639725
Provider Name (Legal Business Name): SHANA MEGHAN WEBB ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 HARRISON AVE SUITE 101
PANAMA CITY FL
32405-4424
US

IV. Provider business mailing address

2507 HARRISON AVE SUITE 101
PANAMA CITY FL
32405-4424
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-5911
  • Fax:
Mailing address:
  • Phone: 850-215-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9278679
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9278679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: