Provider Demographics
NPI:1154102069
Name:SMITH, SHARON ANNETTE (RN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANNETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6165
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78683-6165
Mailing Address - Country:US
Mailing Address - Phone:512-737-9087
Mailing Address - Fax:
Practice Address - Street 1:5028 YUCCA FLOWER LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-2330
Practice Address - Country:US
Practice Address - Phone:737-215-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1060730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse