Provider Demographics
NPI:1427019892
Name:STORM, SHANNON (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CENTERVILLE RD
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4655
Mailing Address - Country:US
Mailing Address - Phone:850-877-3549
Mailing Address - Fax:850-671-2971
Practice Address - Street 1:1405 CENTERVILLE RD
Practice Address - Street 2:SUITE 4200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4655
Practice Address - Country:US
Practice Address - Phone:850-877-3549
Practice Address - Fax:850-671-2971
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1119782363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP08103Medicare UPIN
FLE4222ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER