Provider Demographics
NPI:1710078878
Name:SHERIDAN, STEPHANIE (ANP, MSN, CDN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:ANP, MSN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 LIFESTYLE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4907
Mailing Address - Country:US
Mailing Address - Phone:423-602-2750
Mailing Address - Fax:423-602-2762
Practice Address - Street 1:2358 LIFESTYLE WAY STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4907
Practice Address - Country:US
Practice Address - Phone:423-602-2750
Practice Address - Fax:423-602-2762
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012194363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health