MEDICARE: HELANA THERESE SHANKS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11003725	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083254627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELANA THERESE SHANKS FNP-C

Provider Business Mailing Address
First Line	:	2049 SW 75TH AVE
Second Line	:
City	:	BELL
State	:	FL
Zip	:	32619-4635
Country	:	US
Telephone Number	:	904-629-0986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2049 SW 75TH AVE
Second Line	:
City	:	BELL
State	:	FL
Zip	:	32619-4635
Country	:	US
Telephone Number	:	904-629-0986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2020
Last Update Date	:	01/12/2020

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