Individual
MRS. SHANNON IRENE DEPENZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCM
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-9947
(888) 410-0935
Mailing address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-9947
(888) 410-0935
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
RN3298632
FL
Other
Enumeration date
07/25/2024
Last updated
07/25/2024
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