Provider Demographics
NPI:1366745234
Name:BATES, SHONNA SAMANTHA (APRN)
Entity type:Individual
Prefix:
First Name:SHONNA
Middle Name:SAMANTHA
Last Name:BATES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:200 HEALTHCARE WAY UNIT 200
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-3670
Practice Address - Country:US
Practice Address - Phone:941-261-0145
Practice Address - Fax:941-261-0150
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 11322-NP363LW0102X
FLAPRN9460383363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health