Shannon Creedon, CPNP
Nurse Practitioner, Pediatrics in Port Charlotte, FL. Individual provider (NPI-1).
NPI number1548639487
StatusActive
Last updated in NPPESJul 30, 2021
Details
- NPI
- 1548639487
- Entity type
- Individual (NPI-1)
- Name
- Shannon Creedon
- Credential
- CPNP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 22, 2015
- Certification date
- Jul 29, 2021
- Last updated
- Jul 30, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | APRN11014376 | FL | Yes |
| 163W00000X | Registered Nurse | 686564 | NY |
Practice location
3488 Depew AvePort Charlotte, FL 33952-7015
Phone 941-764-7923
Mailing address
47 Briggsboro LnFairport, NY 14450-3805
Phone 315-507-1878
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