Provider Demographics
NPI:1205137700
Name:TINDELL, SHAWNA CHARISE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:CHARISE
Last Name:TINDELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 CORPORATE LAKE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2365
Mailing Address - Country:US
Mailing Address - Phone:386-288-8868
Mailing Address - Fax:855-243-6983
Practice Address - Street 1:9009 CORPORATE LAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634
Practice Address - Country:US
Practice Address - Phone:386-288-8868
Practice Address - Fax:855-243-6983
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN306208 COA11977363LF0000X
FLARNP9422520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily