Provider Demographics
NPI:1144619784
Name:SHARPE, INGRID R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:R
Last Name:SHARPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1980 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3167
Mailing Address - Country:US
Mailing Address - Phone:805-583-5555
Mailing Address - Fax:805-583-5554
Practice Address - Street 1:1980 SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3167
Practice Address - Country:US
Practice Address - Phone:805-583-5555
Practice Address - Fax:805-583-5554
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA52257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant