Provider Demographics
NPI:1326594185
Name:RICCI, SHAUNA (DNP, RN, ARNP, CPNP)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:RICCI
Suffix:
Gender:F
Credentials:DNP, RN, ARNP, CPNP
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:AFTON
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 CARTERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6327
Mailing Address - Country:US
Mailing Address - Phone:405-760-4718
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST BLDG 700-A78
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL936450363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics