Provider Demographics
NPI:1760677488
Name:JAQUITH, SHARON MCKINNEY (APN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MCKINNEY
Last Name:JAQUITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 MEGGISON RD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-3024
Mailing Address - Country:US
Mailing Address - Phone:523-995-5573
Mailing Address - Fax:484-450-2617
Practice Address - Street 1:3717 MEGGISON RD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-3024
Practice Address - Country:US
Practice Address - Phone:523-995-5573
Practice Address - Fax:484-450-2617
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX432935363LF0000X
FL9289820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1760677488Medicaid
TX432935OtherLICENSE