Provider Demographics
NPI:1558560243
Name:TRAYLOR, SHARON MAULDEN (ARNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MAULDEN
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MAULDEN
Other - Last Name:LOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:209 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3518
Mailing Address - Country:US
Mailing Address - Phone:229-758-4265
Mailing Address - Fax:229-758-8473
Practice Address - Street 1:209 N CUTHBERT ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3518
Practice Address - Country:US
Practice Address - Phone:229-758-4265
Practice Address - Fax:229-758-8473
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286002363LF0000X
FLARNP2800122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003220858AMedicaid
FL302246300Medicaid
Y7409OtherBLUE CROSS BLUE SHIELD
E2663YMedicare PIN