Provider Demographics
NPI:1457718538
Name:SHARPE, OLIVER DERICK (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:DERICK
Last Name:SHARPE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:OLIVER
Other - Middle Name:DERICK
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4889 SINCLAIR RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5433
Mailing Address - Country:US
Mailing Address - Phone:614-396-7582
Mailing Address - Fax:937-806-4095
Practice Address - Street 1:121 KENNEDY PARK DR
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-6501
Practice Address - Country:US
Practice Address - Phone:614-817-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty