Provider Demographics
NPI:1114466125
Name:SHARP, JACQUELINE (DNP-APRN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:DNP-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 MACON TER
Mailing Address - Street 2:SUIE 103
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8505
Mailing Address - Country:US
Mailing Address - Phone:901-757-0568
Mailing Address - Fax:901-754-8247
Practice Address - Street 1:8316 MACON TER
Practice Address - Street 2:SUIE 103
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8505
Practice Address - Country:US
Practice Address - Phone:901-757-0568
Practice Address - Fax:901-754-8247
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000022297363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health