Shenell Forman, APRN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN11036240 Issued in FL

Practice address

5985 Silver Falls Run Ste 200
Bradenton, FL 34211-1291

Phone

(941) 907-4737

NPI assigned

Dec 23, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

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

• Florida Cancer Specialists & Research Institute, LLC

  • Medical Oncology Physician
  • Cape Coral, FL
  • NPI 1760590962
  Medicare reassignment NPD
• Florida Cancer Specialists & Research Institute, LLC

  • Medical Oncology Physician
  • Bradenton, FL
  • NPI 1508973231
  NPD (past)

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

{
    "created_epoch": "1734912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1962210898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102222",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682222",
            "telephone_number": "239-274-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5985 SILVER FALLS RUN STE 200",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342111291",
            "telephone_number": "941-907-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "SHENELL",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-23",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN11036240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Fonville, APRN
• Erin R Ford, ED.S., NCSP
• Rimma Fordham, APRN
• Brendon Michael Fordyce, RRT
• Cathleen Fordyce
• Maria Fornataro
• Jennifer Ann Fornicola, APRN
• Farhad Foroughi, D.M.D.
• Fort Myers Beach Pharmacy
• Michael Gregory Foss

• Gerontology Nurse Practitioner in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.