Provider Demographics
NPI:1689620247
Name:GROW, SHANNON (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:GROW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5258 SE 44TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-4917
Mailing Address - Country:US
Mailing Address - Phone:352-624-2767
Mailing Address - Fax:
Practice Address - Street 1:9580 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-8772
Practice Address - Country:US
Practice Address - Phone:352-633-0703
Practice Address - Fax:352-633-2232
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2151012163W00000X
FL11004142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse