Provider Demographics
NPI:1447633763
Name:MILAM, SHANNON LORRAINE (ARNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LORRAINE
Last Name:MILAM
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LORRAINE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2788
Practice Address - Country:US
Practice Address - Phone:561-564-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9278663208D00000X
FLAPRN9278663363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIM409ZOtherMEDICARE PTAN