Provider Demographics
NPI:1245764737
Name:BLACKSHIRE-TUBIE, SHARON (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:BLACKSHIRE-TUBIE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20755 GREENFIELD RD
Mailing Address - Street 2:#203
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5403
Mailing Address - Country:US
Mailing Address - Phone:248-395-2206
Mailing Address - Fax:248-395-0456
Practice Address - Street 1:20755 GREENFIELD RD
Practice Address - Street 2:#203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5403
Practice Address - Country:US
Practice Address - Phone:248-395-2206
Practice Address - Fax:248-395-0456
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242202207RN0300X, 363LA2200X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4341231Medicaid
MIG81616Medicare UPIN
MI0N63410Medicare PIN