Provider Demographics
NPI:1124565031
Name:MAKOVIC, SHANNON EILEEN KATILUS (DNP, ARNP, NNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:EILEEN KATILUS
Last Name:MAKOVIC
Suffix:
Gender:F
Credentials:DNP, ARNP, NNP-BC
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:EILEEN
Other - Last Name:KATILUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PEDIATRICS NEONATOLOGY
Mailing Address - Street 2:BOX 100296
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-273-8985
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PEDIATRICS NEONATOLOGY
Practice Address - Street 2:BOX 100296
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0296
Practice Address - Country:US
Practice Address - Phone:352-273-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLARNP9336257363LN0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020511800Medicaid