Provider Demographics
NPI:1669463907
Name:MARRS, SHARON J (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:MARRS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3103 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4738
Practice Address - Country:US
Practice Address - Phone:260-373-9300
Practice Address - Fax:260-373-9303
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001078A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200320750Medicaid
IN500017473OtherRAILROAD MEDICARE
IN200320750Medicaid
IN925500BBMedicare PIN