Provider Demographics
NPI:1447239215
Name:KEATING, SHANNON M (APRN)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:KEATING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:LITTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:468 SW 15TH DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7220
Mailing Address - Country:US
Mailing Address - Phone:561-866-5427
Mailing Address - Fax:
Practice Address - Street 1:901 45TH ST
Practice Address - Street 2:
Practice Address - City:MANGONIA PARK
Practice Address - State:FL
Practice Address - Zip Code:33407-2413
Practice Address - Country:US
Practice Address - Phone:561-882-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-990109363LA2100X
FLAPRN9189449363L00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY044EOtherBCBS
FL305951100Medicaid
P79407Medicare UPIN
FLU0046ZMedicare ID - Type Unspecified
FLY044EOtherBCBS
FLU0046YMedicare ID - Type Unspecified
FLU0046WMedicare PIN