Provider Demographics
NPI:1790142511
Name:CARRASCO, SHANNON MURPHY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MURPHY
Last Name:CARRASCO
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 1:26540 ACE AVE STE 108C
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-8279
Mailing Address - Country:US
Mailing Address - Phone:352-326-5281
Mailing Address - Fax:352-323-1761
Practice Address - Street 1:26540 ACE AVE STE 108C
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-8279
Practice Address - Country:US
Practice Address - Phone:352-326-5281
Practice Address - Fax:352-323-1761
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9181013363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care