Provider Demographics
NPI:1043285091
Name:LEE, SHAWN M (ACNP-BC, FNP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:ACNP-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8150
Mailing Address - Fax:850-863-4152
Practice Address - Street 1:2001 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8826
Practice Address - Country:US
Practice Address - Phone:508-863-8219
Practice Address - Fax:850-863-8249
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1002036363L00000X
TX657084363LA2100X
TNAPN0000013553363LA2100X
NC5010186363LF0000X
FLAPRN11003995363LF0000X
FL11003995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC410059000Medicaid