Provider Demographics
NPI:1831652031
Name:SHOEMAKER, MALISSA M (APRNCRNA)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:M
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:APRNCRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2219
Mailing Address - Country:US
Mailing Address - Phone:941-366-1164
Mailing Address - Fax:941-365-1387
Practice Address - Street 1:1261 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2219
Practice Address - Country:US
Practice Address - Phone:941-366-1164
Practice Address - Fax:941-365-1387
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.019939367500000X
FLAPRN11010463367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered