Healthcare Provider Details

I. General information

NPI: 1497326920
Provider Name (Legal Business Name): SHANNON ROXSANNE BURGOS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 CORTEZ BLVD
WEEKI WACHEE FL
34613-6389
US

IV. Provider business mailing address

10065 CORTEZ BLVD
WEEKI WACHEE FL
34613-6389
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-4660
  • Fax: 352-596-4674
Mailing address:
  • Phone: 352-596-4660
  • Fax: 352-596-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11013994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: