Provider Demographics
NPI:1376708347
Name:HART, SHARON L (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520558
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99652-0558
Mailing Address - Country:US
Mailing Address - Phone:907-892-8945
Mailing Address - Fax:
Practice Address - Street 1:MILE 69.1 PARKS HIGHWAY
Practice Address - Street 2:
Practice Address - City:WILLOW
Practice Address - State:AK
Practice Address - Zip Code:99688
Practice Address - Country:US
Practice Address - Phone:907-495-4362
Practice Address - Fax:907-495-4363
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant