Provider Demographics
NPI:1760460042
Name:FAIN, SHERYL (CRNP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:FAIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4562 E HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8831
Mailing Address - Country:US
Mailing Address - Phone:334-263-2301
Mailing Address - Fax:334-263-0881
Practice Address - Street 1:4562 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8831
Practice Address - Country:US
Practice Address - Phone:334-832-4338
Practice Address - Fax:334-832-9971
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-037805363LF0000X
FLARNP9397231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517693OtherBCBS
AL630902047Medicaid
AL630900047Medicaid
AL630903047Medicaid
AL51517694OtherBCBS
ALS34455Medicare UPIN
AL630902047Medicaid