Provider Demographics
NPI:1619533973
Name:STAMPER, SHARETTA
Entity Type:Individual
Prefix:
First Name:SHARETTA
Middle Name:
Last Name:STAMPER
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 1:11508 JOHNSON CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9322
Mailing Address - Country:US
Mailing Address - Phone:904-343-7626
Mailing Address - Fax:
Practice Address - Street 1:11508 JOHNSON CREEK CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9322
Practice Address - Country:US
Practice Address - Phone:904-343-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker