Provider Demographics
NPI:1639700503
Name:FITZPATRICK, SHANNON (FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402609
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2609
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:866-347-1426
Practice Address - Street 1:2120 E JOHNSON AVE STE 106
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6091
Practice Address - Country:US
Practice Address - Phone:850-494-3954
Practice Address - Fax:844-624-7688
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23574363LF0000X
FLAPRN11016034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily