1548207335 NPI number — MISS SHARINE T WISHART APRN

Table of content: MISS SHARINE T WISHART APRN (NPI 1548207335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548207335 NPI number — MISS SHARINE T WISHART APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISHART
Provider First Name:
SHARINE
Provider Middle Name:
T
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548207335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1032 E BRANDON BLVD STE 4567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33511-5509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-474-5844
Provider Business Mailing Address Fax Number:
877-804-1324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1516 E COLONIAL DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-4726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-419-0794
Provider Business Practice Location Address Fax Number:
407-557-4832
Provider Enumeration Date:
06/01/2006

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: 363LF0000X , with the licence number:  ARNP3253512 , 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: 307662800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01223409 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 465046 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 120076400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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