Provider Demographics
NPI:1467834929
Name:KINNEBREW, SHERRYE (APRN)
Entity Type:Individual
Prefix:
First Name:SHERRYE
Middle Name:
Last Name:KINNEBREW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHERRYE
Other - Middle Name:
Other - Last Name:FRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14250 FALCONHEAD CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3801
Mailing Address - Country:US
Mailing Address - Phone:904-333-1340
Mailing Address - Fax:
Practice Address - Street 1:9250 CYPRESS GREEN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1885
Practice Address - Country:US
Practice Address - Phone:904-269-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9319673363LA2200X, 363LG0600X
FL9319673363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology