Provider Demographics
NPI:1255688875
Name:CHARLES, SHARON (APRN)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1450
Mailing Address - Country:US
Mailing Address - Phone:813-253-6250
Mailing Address - Fax:
Practice Address - Street 1:111 NORTH BREVARD AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602
Practice Address - Country:US
Practice Address - Phone:813-253-6250
Practice Address - Fax:813-258-7413
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254332363L00000X
FLAPRN9254332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006508900Medicaid
FL006508900Medicaid