Provider Demographics
NPI:1538583786
Name:ROSBOROUGH, SHANNON (RN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:ROSBOROUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:16003 RIDLEY PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2050
Mailing Address - Country:US
Mailing Address - Phone:910-381-1178
Mailing Address - Fax:
Practice Address - Street 1:16003 RIDLEY PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2050
Practice Address - Country:US
Practice Address - Phone:910-381-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-08
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN93592742865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital