Provider Demographics
NPI:1275524258
Name:SHARP, LISA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SHARP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 EAST MEDICAL DR.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2000
Mailing Address - Country:US
Mailing Address - Phone:801-292-1464
Mailing Address - Fax:801-292-1465
Practice Address - Street 1:520 EAST MEDICAL DR.
Practice Address - Street 2:SUITE 301
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-2000
Practice Address - Country:US
Practice Address - Phone:801-292-1464
Practice Address - Fax:801-292-1465
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007084405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP16356Medicare UPIN