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General NPI Number Information
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NPI Number | 1821649211
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Entity Type | Individual
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Provider Name | SHANNON TRACY GHATTAS
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 580 VILLAGE BLVD STE 270
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-1951
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Country | US
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Telephone | 561-247-5658
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Fax | 561-725-7937
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Provider Business Mailing Address
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Address Line | 580 VILLAGE BLVD STE 270
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-1951
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Country | US
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Telephone | 561-247-5658
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Fax | 561-725-7937
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11004145
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License Number State | FL
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