Provider Demographics
NPI:1760471510
Name:HERNLY, SHARON K (RN, MSN, ANP, CGNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:K
Last Name:HERNLY
Suffix:
Gender:F
Credentials:RN, MSN, ANP, CGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13634 N 93RD AVE
Mailing Address - Street 2:#100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-933-0301
Mailing Address - Fax:623-933-0224
Practice Address - Street 1:18731 N REEMS RD
Practice Address - Street 2:#680
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-975-0592
Practice Address - Fax:623-975-0750
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN098246363LG0600X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN098246OtherSTATE LICENSE
AZ726664Medicaid
AZ726664Medicaid
AZMH0055271OtherDEA
S62817Medicare UPIN
AZ726664Medicaid