Provider Demographics
NPI:1124182514
Name:CAMPBELL, SHARON L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 5TH STREET NORTH #200
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:404-755-8996
Mailing Address - Fax:404-755-0570
Practice Address - Street 1:1188 RALPH DAVID ABERNATHY BLVD WEST END
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1716
Practice Address - Country:US
Practice Address - Phone:404-755-0570
Practice Address - Fax:404-755-0520
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN121520363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA978833161AMedicaid
GA5OBBHZKMedicare ID - Type Unspecified