Provider Demographics
NPI:1619693223
Name:CARAVETTA, SHARON LEIGH (FNP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LEIGH
Last Name:CARAVETTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:LEIGH
Other - Last Name:RADKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1123 E OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2633
Mailing Address - Country:US
Mailing Address - Phone:602-300-1669
Mailing Address - Fax:
Practice Address - Street 1:127 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5646
Practice Address - Country:US
Practice Address - Phone:928-468-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN186283163W00000X
AZ277294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse