MEDICARE: MRS. SHANNON SUE GRASS ANP

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	APRN9205247	FL
2	363L00000X	Nurse Practitioner	2014003270	MO

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	:	1427247790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON SUE GRASS ANP

Provider Business Mailing Address
First Line	:	2831 SW 39TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-2807
Country	:	US
Telephone Number	:	727-365-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 SW 39TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-2807
Country	:	US
Telephone Number	:	727-365-7600
Fax Number	:

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

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	08/18/2025

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