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General NPI Number Information
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NPI Number | 1679924146
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Entity Type | Individual
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Provider Name | SHANE LYNN PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 2710 PALM HARBOR BLVD # 403B
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City | PALM HARBOR
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State | FL
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Zip | 34683-2666
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Country | US
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Telephone | 277-275-3601
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Fax | 727-238-8137
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Provider Business Mailing Address
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Address Line | 2710 ALTERNATE 19 N 403B
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City | PALM HARBOR
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State | FL
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Zip | 34683-5915
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Country | US
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Telephone | 727-275-3601
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Fax | 727-238-8137
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP129984
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN9398198
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License Number State | FL
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