Provider Demographics
NPI:1073015384
Name:HOLBROOK, SHARON MICHELLE (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MICHELLE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 12TH ST SW STE 2
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4720
Mailing Address - Country:US
Mailing Address - Phone:706-295-6701
Mailing Address - Fax:
Practice Address - Street 1:310 N RIVER ST NW
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-9408
Practice Address - Country:US
Practice Address - Phone:706-624-1444
Practice Address - Fax:706-624-1471
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175411363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology