Individual
MR. SHAUGHN RANDALL WHITTAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1720 S ORANGE AVE, ORLANDO, FL 32806-2945
(321) 842-9000
(321) 843-6326
Mailing address
1720 S ORANGE AVE, ORLANDO, FL 32806-2945
(321) 842-9000
(321) 843-6326
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11002533
FL
363LF0000X
Family Nurse Practitioner
95012121
CA
363LF0000X
Family Nurse Practitioner
APRN11002533
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116630600
—
FL
01
—
VN622
MEDICARE HF
FL
Enumeration date
08/01/2019
Last updated
07/03/2025
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