Individual provider Active NPI

Canisha Shanara Gillon, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Winter Haven, FL
National Provider Identifier
1063981892
Registry record updated Mar 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
9328108 Issued in FL
Practice address
1201 1St St S
Winter Haven, FL 33880-3904
Phone
(863) 294-7062
NPI assigned
Nov 22, 2018
Last updated
Mar 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 9328108 FL Primary

Addresses

Primary practice location

1201 1St St S
Winter Haven, FL 33880-3904

Mailing address

2995 Drew St FL 2
Clearwater, FL 33759-3012
Phone (727) 532-0002

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Canisha.GillonAPRN@direct.mybaycare.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA, NC3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190122000623 FL Practitioner - Nurse Practitioner 0446597009 Reassigns benefits to 3 organizations
I20230414000045 GA Practitioner - Nurse Practitioner 0446597009 Reassigns benefits to 2 organizations
I20251212002269 NC Practitioner - Nurse Practitioner 0446597009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1604 Corey Wood Cir
Tallahassee, FL 32304-3763

1717 Main St
Suite 5850
Dallas, TX 75201-4681

1717 Main St
Suite 5850
Dallas, TX 75201-7317

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9328108FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC CurrentSince Apr 3, 2023 Accepting new patients
MCR Health, Inc. CurrentSince Jun 6, 2022 Accepting new patients
Balanced Wellbeing LLC CurrentSince Mar 1, 2022 Accepting new patients
Privia Medical Group of Georgia LLC CurrentSince Apr 3, 2023 Accepting new patients
Winter Haven Hospital Inc CurrentSince Jan 26, 2026 Accepting new patients
Aimergency Connectcare, LLC CurrentSince Oct 20, 2023 Accepting new patients
Apalachee Center, Inc. Current Accepting new patients
Forefront-Matteson Medical Services PC CurrentSince Nov 20, 2025 Accepting new patients
MCR Health, Inc. CurrentSince Jun 6, 2022 Accepting new patients

Locations

2995 Drew St
Fl 2
Clearwater, FL 33759
Phone (727) 315-7234

3200 SW 34th Ave
Ste 701
Ocala, FL 34474
Phone (354) 445-1200

12271 US Highway 301 N
Parrish, FL 34219
Phone (941) 713-2231

2634 Capital Cir NE
Bldg B
Tallahassee, FL 32308
Phone (850) 487-2930

2634 Capital Cir NE
Bldg J
Tallahassee, FL 32308
Phone (850) 523-3243

1201 1st St S
Winter Haven, FL 33880
Phone (863) 294-7062

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

2810 Coliseum Centre Dr
Ste 120
Charlotte, NC 28217

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

Interoperability endpoints

  • Direct secure messaging: canisha.gillonaprn@direct.mybaycare.org
  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1063981892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 DREW ST FL 2",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337593012",
            "telephone_number": "727-532-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 1ST ST S",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803904",
            "telephone_number": "863-294-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLON",
        "first_name": "CANISHA",
        "middle_name": "SHANARA",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-22",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "9328108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Canisha.GillonAPRN@direct.mybaycare.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1201 1st St S",
            "city": "Winter Haven",
            "state": "FL",
            "country_code": "US",
            "postal_code": "338803904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

Verify at the official NPI Registry.