Provider Demographics
NPI:1497194534
Name:LEONARD, SHANNAN MARIA (FNP)
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:MARIA
Last Name:LEONARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3448
Mailing Address - Country:US
Mailing Address - Phone:321-843-7497
Mailing Address - Fax:321-843-7497
Practice Address - Street 1:9900 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3448
Practice Address - Country:US
Practice Address - Phone:321-843-7497
Practice Address - Fax:321-843-7497
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008729363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO4069OtherMEDICARE HF
FL114377000Medicaid