Individual
HANNA RAE SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12700 CREEKSIDE LN STE 301, FORT MYERS, FL 33919-3356
(239) 343-3780
(239) 343-3781
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9960
(239) 424-4006
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9114423
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111306100
—
FL
Enumeration date
04/20/2020
Last updated
07/02/2024
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