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General NPI Number Information
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NPI Number | 1154953214
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Entity Type | Individual
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Provider Name | SHANNA NICOLE ROARK APRN, MSN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 1111 MEDICAL PLAZA DR STE 250
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City | SHENANDOAH
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State | TX
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Zip | 77380-3477
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Country | US
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Telephone | 281-296-8788
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Fax |
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Provider Business Mailing Address
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Address Line | 319 WILD BIRD DR
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City | SPRING
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State | TX
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Zip | 77373-8382
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Country | US
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Telephone | 713-294-6309
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Fax |
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | AP145040
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License Number State | TX
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