Provider Demographics
NPI:1225340854
Name:SPOEDE, SHARON LYN (ARNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYN
Last Name:SPOEDE
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:990 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5403
Practice Address - Country:US
Practice Address - Phone:239-434-6300
Practice Address - Fax:239-434-7174
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9187251363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00252200Medicaid
FLY04WCOtherBLUE CROSS BLUE SHIELD
FLY04WCOtherBCBS OF FL
DK661ZMedicare PIN
FLY04WCOtherBCBS OF FL