Provider Demographics
NPI:1083158893
Name:ROBERTS, SHAWNA COLLEEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:COLLEEN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 NORTH WAY
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-9181
Mailing Address - Country:US
Mailing Address - Phone:912-437-2442
Mailing Address - Fax:
Practice Address - Street 1:1010 MEDICAL CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-3450
Practice Address - Country:US
Practice Address - Phone:843-645-8220
Practice Address - Fax:843-645-8221
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily