Provider Demographics
NPI:1649303884
Name:TICE, SHARON FLEMING (RN)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:FLEMING
Last Name:TICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19870 KATY WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4223
Mailing Address - Country:US
Mailing Address - Phone:951-358-5190
Mailing Address - Fax:951-358-4474
Practice Address - Street 1:9707 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3609
Practice Address - Country:US
Practice Address - Phone:951-358-5190
Practice Address - Fax:951-358-4474
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361833163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health