MEDICARE: SHAWN MARIE DAGUE ARNP, CNM

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	363L00000X	Nurse Practitioner	ARNP9291971	FL
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP9291971	FL
3	367A00000X	Advanced Practice Midwife	ARNP9291971	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245248871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN MARIE DAGUE ARNP, CNM

Provider Business Mailing Address
First Line	:	150 N SYKES CREEK PKWY STE 300
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3488
Country	:	US
Telephone Number	:	321-459-1192
Fax Number	:	321-459-2304

Provider Business Practice Location Address
First Line	:	150 N SYKES CREEK PKWY STE 300
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3488
Country	:	US
Telephone Number	:	321-459-1192
Fax Number	:	321-459-2304

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/31/2025

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