Individual
MS. SHANNON MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1096
(305) 585-8508
Mailing address
6006 NW 78TH TER, TAMARAC, FL 33321-4648
(954) 849-8424
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
ARNP9304496
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN9304496
FL
Other
Enumeration date
01/01/2015
Last updated
06/20/2024
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