Provider Demographics
NPI:1023193364
Name:AUCOIN, SHERRY A (NP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:AUCOIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1319
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22199-1319
Mailing Address - Country:US
Mailing Address - Phone:727-452-1871
Mailing Address - Fax:
Practice Address - Street 1:2555 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:EDGARD
Practice Address - State:LA
Practice Address - Zip Code:70049-2417
Practice Address - Country:US
Practice Address - Phone:985-267-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171174363LF0000X
DCRN1031429363LF0000X
LAAP05043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1001325Medicaid