Provider Demographics
NPI:1063669216
Name:NORMAN-SPURLOCK, SHANNON LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNNE
Last Name:NORMAN-SPURLOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 61ST ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4162
Mailing Address - Country:US
Mailing Address - Phone:727-798-3699
Mailing Address - Fax:
Practice Address - Street 1:2501 61ST ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4162
Practice Address - Country:US
Practice Address - Phone:727-798-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9278249163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse