Provider Demographics
NPI:1497326920
Name:BURGOS, SHANNON ROXSANNE (APRN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROXSANNE
Last Name:BURGOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6329 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6037
Mailing Address - Country:US
Mailing Address - Phone:727-844-5555
Mailing Address - Fax:727-844-5553
Practice Address - Street 1:11123 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5615
Practice Address - Country:US
Practice Address - Phone:352-666-5555
Practice Address - Fax:352-666-2915
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily