Provider Demographics
NPI:1679601595
Name:MERTINS, SHARON LEONE (PAC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEONE
Last Name:MERTINS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:480-963-1853
Mailing Address - Fax:480-963-1854
Practice Address - Street 1:1343 N ALMA SCHOOL RD
Practice Address - Street 2:STE 160
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5901
Practice Address - Country:US
Practice Address - Phone:480-963-1853
Practice Address - Fax:480-963-1854
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
CAPA17685363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA176850Medicare UPIN