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General NPI Number Information
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NPI Number | 1093903270
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Entity Type | Individual
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Provider Name | SHANA S O'ROARK RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 1255 W 15TH ST STE 100
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City | PLANO
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State | TX
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Zip | 75075-7262
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Country | US
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Telephone | 888-562-5442
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Fax | 562-499-6171
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Provider Business Mailing Address
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Address Line | 200 OCEANGATE STE 100
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City | LONG BEACH
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State | CA
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Zip | 90802-4317
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Country | US
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Telephone | 562-435-3666
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Fax | 562-499-6171
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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 | 620562
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 85787
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License Number State | NM
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