Provider Demographics
NPI:1467028688
Name:SHARPE, COURTNEY ROYAL
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ROYAL
Last Name:SHARPE
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 1:12413 RIVERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8213
Mailing Address - Country:US
Mailing Address - Phone:865-816-7360
Mailing Address - Fax:
Practice Address - Street 1:12413 RIVERGLEN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-8213
Practice Address - Country:US
Practice Address - Phone:865-816-7360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12625310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility