Provider Demographics
NPI:1174894729
Name:VINCENT, SHARON DENISE (LPN)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DENISE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 FRAGGLE ROC
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-2882
Mailing Address - Country:US
Mailing Address - Phone:678-615-9201
Mailing Address - Fax:
Practice Address - Street 1:2517 FRAGGLE ROC
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-2882
Practice Address - Country:US
Practice Address - Phone:678-615-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN065665164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse