Healthcare Provider Details

I. General information

NPI: 1720865819
Provider Name (Legal Business Name): SHONDA YVONNE COMBS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 6TH AVE S STE 350
ST PETERSBURG FL
33701-4619
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 727-456-0080
  • Fax:
Mailing address:
  • Phone: 132-860-0338
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11028623
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: