Provider Demographics
NPI:1538672126
Name:JOHNSON, SHARANNA SHARMEL
Entity Type:Individual
Prefix:
First Name:SHARANNA
Middle Name:SHARMEL
Last Name:JOHNSON
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 1:9998 EAGLE CREEK CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6333
Mailing Address - Country:US
Mailing Address - Phone:918-752-5472
Mailing Address - Fax:
Practice Address - Street 1:1309 COFFEEN AVE
Practice Address - Street 2:STE 1200
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5777
Practice Address - Country:US
Practice Address - Phone:407-833-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA163943363L00000X, 363LF0000X
AZ248402363LF0000X
FL9481943363LF0000X
TN29936363LF0000X
WY46550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner