Provider Demographics
NPI:1891191821
Name:POWERS, SHANTAL (ARNP)
Entity Type:Individual
Prefix:
First Name:SHANTAL
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHANTAL
Other - Middle Name:
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6210 SCOTT ST
Mailing Address - Street 2:UNIT 216
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950
Mailing Address - Country:US
Mailing Address - Phone:941-655-8281
Mailing Address - Fax:941-347-8749
Practice Address - Street 1:6210 SCOTT ST UNIT 216
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3901
Practice Address - Country:US
Practice Address - Phone:941-655-8281
Practice Address - Fax:941-347-8749
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9277949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015616200Medicaid
FLIC717XMedicare PIN
FL7571790OtherCIGNA
FLP01652158OtherRR MEDICARE
FL5896841OtherAETNA
FLY0PQ0OtherBCBS