Provider Demographics
NPI:1619156759
Name:TAVAREZ, SHERRY JANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:JANE
Last Name:TAVAREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SHERRY
Other - Middle Name:JANE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:221 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5066
Mailing Address - Country:US
Mailing Address - Phone:850-833-9240
Mailing Address - Fax:
Practice Address - Street 1:349 HOLMES BLVD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4150
Practice Address - Country:US
Practice Address - Phone:850-833-3364
Practice Address - Fax:850-833-3366
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9233170163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool