Provider Demographics
NPI:1346665510
Name:SHANNON R. WEBER ARNP LLC
Entity Type:Organization
Organization Name:SHANNON R. WEBER ARNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-205-3004
Mailing Address - Street 1:1504 FAHNSTOCK ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-5731
Mailing Address - Country:US
Mailing Address - Phone:352-205-3004
Mailing Address - Fax:
Practice Address - Street 1:1504 FAHNSTOCK ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-5731
Practice Address - Country:US
Practice Address - Phone:352-205-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3360292282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital