Twin Ports Telemedicine LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

TWIN PORTS TELEMEDICINE LLC

Practice address

4727 Aune Rd
Saginaw, MN 55779-9682

Phone

(218) 391-6264

NPI assigned

Apr 2, 2024

Organization subpart

No

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

Authorized official

Name

Nicole Shockley, APRNNPI 1124569041

Title

Owner

Phone

(888) 820-1235

Specialties & licenses 1

Addresses

Other names 1

• Twin Ports Telemedicine Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Shockley, CNP

  • Nurse Practitioner
  • Duluth, MN
  • NPI 1124569041
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1831941970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4727 AUNE RD",
            "city": "SAGINAW",
            "state": "MN",
            "postal_code": "557799682",
            "telephone_number": "218-391-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4727 AUNE RD",
            "city": "SAGINAW",
            "state": "MN",
            "postal_code": "557799682",
            "telephone_number": "218-391-6264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN PORTS TELEMEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "SHOCKLEY",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-820-1235",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twin Ports Telemedicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Twin Ports Telemedicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northland Afc,Inc
• Northland Afc,Inc
• Melanie S. Olson, LICSW
• Lisa Kay Parrott, RN
• Wendy Lee Stovern, LPN
• Clayton Dennis Warner Sr.

• Primary Care Nurse Practitioner in Saginaw, MN
• Providers in Saginaw, MN by specialty
• Primary Care Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.