Provider Demographics
NPI:1235623901
Name:SHARPE CONCIERGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SHARPE CONCIERGE HEALTHCARE LLC
Other - Org Name:SHARPE HEALTHCARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-632-0666
Mailing Address - Street 1:302 HARBOUR POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413
Mailing Address - Country:US
Mailing Address - Phone:561-632-0666
Mailing Address - Fax:
Practice Address - Street 1:302 HARBOUR POINTE WAY
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413
Practice Address - Country:US
Practice Address - Phone:561-632-0666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251J00000X, 251T00000X, 253Z00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No251J00000XAgenciesNursing Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care