Individual
SHANNON BOODHWANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
2450 GOODLETTE-FRANK RD N STE 101, NAPLES, FL 34103-4595
(239) 624-8470
Mailing address
2450 GOODLETTE-FRANK RD N STE 101, NAPLES, FL 34103-4595
(239) 624-8470
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN11018802
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114708500
—
FL
01
—
MI6GD
FL BLUE
FL
Enumeration date
02/21/2017
Last updated
03/14/2024
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