Provider Demographics
NPI:1265543896
Name:SPENCER, SHARON L (CRNA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:BOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:402 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3157
Mailing Address - Country:US
Mailing Address - Phone:941-496-9286
Mailing Address - Fax:
Practice Address - Street 1:809 E MARION AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3819
Practice Address - Country:US
Practice Address - Phone:941-637-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP318342367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1655OtherBLUE SHIELD
FLG1655Medicare ID - Type Unspecified