1629091533 NPI number — MS. SHERRY A FREEMAN ARNP

Table of content: MS. SHERRY A FREEMAN ARNP (NPI 1629091533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629091533 NPI number — MS. SHERRY A FREEMAN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
SHERRY
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREEMAN
Provider Other First Name:
SHERRY
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629091533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 NORTHWEST 79TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-661-3460
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 BISCAYNE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33137-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-953-6918
Provider Business Practice Location Address Fax Number:
786-953-6078
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  ARNP 417552 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 303485200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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