Provider Demographics
NPI:1457314304
Name:CICERO, SHARON RENEE (CRNA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RENEE
Last Name:CICERO
Suffix:
Gender:F
Credentials:CRNA
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 415000-MSC8337
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-8337
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:106 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3556
Practice Address - Country:US
Practice Address - Phone:931-454-9810
Practice Address - Fax:931-393-1020
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10106367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4062939OtherBLUECROSS
TNP00021588OtherRAILROAD MEDICARE
TN3625389Medicaid
TN4062939OtherBLUECROSS