MEDICARE: MS. SHANNEN LEA VIXLER ARNP

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	ARNP9198349	FL

General Provider Information

NPI Number	:	1528091998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNEN LEA VIXLER ARNP

Provider Business Mailing Address
First Line	:	PO BOX 984
Second Line	:
City	:	ESTERO
State	:	FL
Zip	:	33929-0984
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13691 METRO PKWY STE 310
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4322
Country	:	US
Telephone Number	:	239-768-1400
Fax Number	:

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/06/2011

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