Provider Demographics
NPI:1659036481
Name:STIPANCIC, SHANNON (ARNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:STIPANCIC
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 1:12744 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5613
Mailing Address - Country:US
Mailing Address - Phone:727-743-6096
Mailing Address - Fax:
Practice Address - Street 1:12744 CORONADO DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5613
Practice Address - Country:US
Practice Address - Phone:727-743-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9175221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner