Provider Demographics
NPI:1417490756
Name:SHIPP, SHANTELL (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANTELL
Middle Name:
Last Name:SHIPP
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 132
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4264
Mailing Address - Country:US
Mailing Address - Phone:480-988-4645
Mailing Address - Fax:
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 132
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4264
Practice Address - Country:US
Practice Address - Phone:480-988-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132368363LF0000X
AZAP10327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily