Provider Demographics
NPI:1205615556
Name:SHAFFER, AMBER DAWN (DNP)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DAWN
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:MAZZOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:11621 S CLEVELAND AVE STE 60
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2866
Mailing Address - Country:US
Mailing Address - Phone:239-410-7713
Mailing Address - Fax:
Practice Address - Street 1:11621 S CLEVELAND AVE STE 60
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2866
Practice Address - Country:US
Practice Address - Phone:239-410-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028809363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner