Provider Demographics
NPI:1215395256
Name:HOLMES, SHANNON (ARNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 EGRET LANDING PL
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3963
Mailing Address - Country:US
Mailing Address - Phone:813-685-4142
Mailing Address - Fax:
Practice Address - Street 1:1202 E PALM AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-3512
Practice Address - Country:US
Practice Address - Phone:813-273-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9322025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily