Provider Demographics
NPI:1376043091
Name:SHARARA, ELIZABETH TAMBUDZAI
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TAMBUDZAI
Last Name:SHARARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 S US HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5707
Mailing Address - Country:US
Mailing Address - Phone:903-532-5656
Mailing Address - Fax:
Practice Address - Street 1:1328 GREENSBORO DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8609
Practice Address - Country:US
Practice Address - Phone:214-952-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225894164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse