Provider Demographics
NPI:1417454265
Name:JERNIGAN, SHERYL A (ARNP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:A
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 WATTS DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352-7334
Mailing Address - Country:US
Mailing Address - Phone:334-701-8838
Mailing Address - Fax:
Practice Address - Street 1:625 W BALDWIN RD STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3359
Practice Address - Country:US
Practice Address - Phone:850-481-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9482655363LF0000X
AL2017017024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily