Individual
MRS. TINA NANNETTE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 935-8538
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 935-8538
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
31865
SC
367500000X
Certified Registered Nurse Anesthetist
54626
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001713630
BCBS-MAAC
WV
05
—
2601300000
—
WV
05
—
2624413
—
OH
01
—
270052997
TAX ID -MAAC
WV
01
—
27005299700
WORKER'S COMP-MAAC
WV
01
—
P00258571
MEDICARE
WV
Enumeration date
05/31/2005
Last updated
07/13/2026
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