Provider Demographics
NPI:1124022975
Name:ROBERTS, SHERRI ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:LIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJAX - DEPT. OF EMERGENCY MEDICINE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-5044
Practice Address - Fax:904-244-5666
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103186363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA130710135BMedicaid
GA130710135AMedicaid
P00232772OtherMEDICARE RAILROAD
FL292046800Medicaid
FLU4123AMedicare PIN
FL292046800Medicaid
FLU4123ZMedicare PIN
GA130710135BMedicaid
FLP01366781Medicare PIN