Provider Demographics
NPI:1164811576
Name:ATKINSON-STATEN, SHARMA (ARNP)
Entity Type:Individual
Prefix:
First Name:SHARMA
Middle Name:
Last Name:ATKINSON-STATEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHARMA
Other - Middle Name:
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 SW BAYA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-4204
Mailing Address - Country:US
Mailing Address - Phone:386-361-3400
Mailing Address - Fax:
Practice Address - Street 1:619 SW BAYA DR STE 102
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4204
Practice Address - Country:US
Practice Address - Phone:386-361-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2718912363LF0000X
FLARNP2718912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily