Individual
SHANNON OVERHOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 KINGSLEY AVE, ORANGE PARK, FL 32073-5148
(904) 639-2000
(904) 639-2015
Mailing address
2001 KINGSLEY AVE, ORANGE PARK, FL 32073-5148
(904) 639-2015
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
155780
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2020
Last updated
06/03/2022
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