Provider Demographics
NPI:1649294380
Name:YORK CONREY, SHANNON M (APRN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:YORK CONREY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:12730 NEW BRITTANY BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4690
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:7381 COLLEGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5527
Practice Address - Country:US
Practice Address - Phone:239-482-1010
Practice Address - Fax:239-481-1481
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3180122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014116700Medicaid
FLY0PT3OtherFLORIDA BLUE