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General NPI Number Information
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NPI Number | 1205421427
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Entity Type | Individual
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Provider Name | SHANNON SWIDERSKI MSN, CRNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 19283 STATE HIGHWAY 59
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City | SUMMERDALE
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State | AL
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Zip | 36580-3005
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Country | US
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Telephone | 251-523-5437
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Fax | 866-628-7517
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | GULF BREEZE
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State | FL
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Zip | 32562-0280
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Country | US
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Telephone | 850-932-5055
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Fax | 850-932-1404
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN11012182
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License Number State | FL
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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 | 1-137654
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License Number State | AL
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