Provider Demographics
NPI:1548773005
Name:MORELAND, SHARON DYAN (APRN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DYAN
Last Name:MORELAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:3434 HANCOCK BRIDGE PKWY STE 309
Practice Address - Street 2:
Practice Address - City:N FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7099
Practice Address - Country:US
Practice Address - Phone:855-674-8800
Practice Address - Fax:239-599-4126
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2113772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022884700Medicaid