Provider Demographics
NPI:1619275559
Name:MCDADE, SHARON R (ANP - BC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:MCDADE
Suffix:
Gender:F
Credentials:ANP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7015 A C SKINNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-7453
Mailing Address - Fax:229-494-9109
Practice Address - Street 1:14546 OLD SAINT AUGUSTINE RD STE 317
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5472
Practice Address - Country:US
Practice Address - Phone:904-260-9445
Practice Address - Fax:904-260-0005
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127394363LA2200X
FLAPRN9439089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSE6I1OtherFLORIDA BLUE
FLL2515OtherMEDICARE