Provider Demographics
NPI:1790036689
Name:DAVIS, SHARON RENAE (FNP - BC)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:RENAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP - BC
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:RENAE
Other - Last Name:ATKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5869 WEST MUIRWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096
Mailing Address - Country:US
Mailing Address - Phone:801-450-8403
Mailing Address - Fax:
Practice Address - Street 1:5869 W MUIRWOOD DR
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-8203
Practice Address - Country:US
Practice Address - Phone:801-450-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT331560-4405364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health