Provider Demographics
NPI:1093321457
Name:LOISELLE, SHERRY BENSON (APRN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:BENSON
Last Name:LOISELLE
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 1:19407 CHARRICE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-5528
Mailing Address - Country:US
Mailing Address - Phone:904-710-4166
Mailing Address - Fax:
Practice Address - Street 1:19407 CHARRICE CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-5528
Practice Address - Country:US
Practice Address - Phone:904-710-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11009115OtherAPRN LICENSE