Active NPI
Colton Shank
- Student in an Organized Health Care Education/Training Program
- Hollywood, FL
National Provider Identifier
1619868189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 3501 Johnson St
Hollywood, FL 33021-5421 - Phone
- (954) 987-2000
- NPI assigned
- Jul 14, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 973026 | TX | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
3501 Johnson St
Hollywood, FL 33021-5421
Mailing address
21592 FM 1954
Holliday, TX 76366-3960
Other practice location 1
9655 Boynton Beach Blvd
Boynton Beach, FL 33472-4421
Phone (561) 336-7000
Other practice location 2
1005 Joe DiMaggio Dr
Hollywood, FL 33021-5402
Phone (954) 265-5324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 973026 | TX | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752451200000",
"number": "1619868189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21592 FM 1954",
"city": "HOLLIDAY",
"state": "TX",
"postal_code": "763663960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3501 JOHNSON ST",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330215421",
"telephone_number": "954-987-2000"
}
],
"practiceLocations": [
{
"address_1": "9655 Boynton Beach Blvd",
"address_purpose": "LOCATION",
"city": "Boynton Beach",
"state": "FL",
"postal_code": "334724421",
"country_code": "US",
"telephone_number": "561-336-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1005 Joe DiMaggio Dr",
"address_purpose": "LOCATION",
"city": "Hollywood",
"state": "FL",
"postal_code": "330215402",
"country_code": "US",
"telephone_number": "954-265-5324",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHANK",
"first_name": "COLTON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-07-14",
"last_updated": "2025-07-14",
"certification_date": "2025-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TX",
"license": "973026",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.