Provider Demographics
NPI:1609020874
Name:MORSE, SHANNON LEIGH (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:LEIGH
Last Name:MORSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19105 N US HIGHWAY 41
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4206
Mailing Address - Country:US
Mailing Address - Phone:813-269-2700
Mailing Address - Fax:813-269-2701
Practice Address - Street 1:19105 N US HIGHWAY 41
Practice Address - Street 2:SUITE 100
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4206
Practice Address - Country:US
Practice Address - Phone:813-269-2700
Practice Address - Fax:813-269-2701
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3415702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily