Provider Demographics
NPI:1558805838
Name:MARTIN, SHANNON CORRIGAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:CORRIGAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:1741 DAVID WALKER DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5745
Mailing Address - Country:US
Mailing Address - Phone:352-742-3578
Mailing Address - Fax:352-742-3581
Practice Address - Street 1:1741 DAVID WALKER DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5745
Practice Address - Country:US
Practice Address - Phone:352-742-3578
Practice Address - Fax:352-742-3581
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL363L00000X363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner