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General NPI Number Information
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NPI Number | 1043285091
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Entity Type | Individual
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Provider Name | SHAWN M. LEE ACNP-BC, FNP
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Gender | Female
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 2001 E HIGHWAY 20
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City | NICEVILLE
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State | FL
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Zip | 32578-8826
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Country | US
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Telephone | 508-863-8219
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Fax | 850-863-8249
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Provider Business Mailing Address
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Address Line | 1005 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6707
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Country | US
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Telephone | 850-863-8150
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Fax | 850-863-4152
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN1002036
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 657084
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APN0000013553
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5010186
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11003995
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11003995
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License Number State | FL
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