Provider Demographics
NPI:1639291370
Name:SHARP, GLORIA JEAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:SHARP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PINELLAS ST STE 320
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3369
Mailing Address - Country:US
Mailing Address - Phone:727-446-2273
Mailing Address - Fax:727-447-5972
Practice Address - Street 1:455 PINELLAS ST STE 320
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3369
Practice Address - Country:US
Practice Address - Phone:727-446-2273
Practice Address - Fax:727-441-4966
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9101473363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21666OtherBCBS
FLY00N2OtherBLUE CROSS BLUE SHIELD
FL292759400Medicaid
FL2122308OtherHUMANA
FLP00433812Medicare PIN
FLAF194ZMedicare PIN