Provider Demographics
NPI:1811628498
Name:WASSON, SHERRI RENE (RN)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:RENE
Last Name:WASSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:RENE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-1559
Mailing Address - Country:US
Mailing Address - Phone:863-519-0575
Mailing Address - Fax:863-582-9251
Practice Address - Street 1:715 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-1908
Practice Address - Country:US
Practice Address - Phone:863-519-0575
Practice Address - Fax:863-582-9251
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9581592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse