Provider Demographics
NPI:1912956921
Name:DONOVAN, SHANNON R (RN, APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:R
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:R
Other - Last Name:BONTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, APRN
Mailing Address - Street 1:4230 HARDING PIKE STE 450
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-6048
Mailing Address - Country:US
Mailing Address - Phone:615-222-3945
Mailing Address - Fax:615-222-5399
Practice Address - Street 1:4230 HARDING PIKE STE 450
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-6048
Practice Address - Country:US
Practice Address - Phone:615-222-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN036654722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000008255OtherADVANCED PRACTICE NURSE
TNFNP036654722OtherFAMILY NURSE PRACTITIONER
TNRN0000134068OtherREGISTERED NURSE
TNMD1045334OtherDEA NUMBER
TNMD1045334OtherDEA NUMBER