Provider Demographics
NPI:1558033571
Name:POWELL, SHARON (APRN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 37TH PL STE 104
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6501
Mailing Address - Country:US
Mailing Address - Phone:772-978-5811
Mailing Address - Fax:772-978-5815
Practice Address - Street 1:1050 37TH PL STE 104
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6501
Practice Address - Country:US
Practice Address - Phone:772-978-5811
Practice Address - Fax:772-978-5815
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9165100163W00000X
FLAPRN11016152363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112502900Medicaid