Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Micaela Rae Shannon

Individual provider Primary Care Nurse Practitioner · NPI 1023654647

Micaela Rae Shannon is a Nurse Practitioner in Jacksonville, Florida. Qualified in 2021, 5 years ago. Practices with Millennium Physician Group LLC, a 970-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
5
Licensed in
FL
In the registry since
2019
Specialties on file
3
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Practice location Address checks out

7016 Normandy Blvd
Jacksonville, FL 32205-6206
Phone: (904) 783-2405
Fax: (904) 420-6101
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APRN11015772 (FL)
Primary Care Nurse Practitioner Taxonomy 363LP2300X · Licence APRN11015772 (FL)
Emergency Registered Nurse Taxonomy 163WE0003X · Licence RN9469517 (FL)

Record details

NPI number1023654647
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 19, 2019
Last updated in NPPESMarch 4, 2024
Certification dateMarch 4, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Millennium Physician Group Llc — 970 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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