Provider Demographics
NPI:1669224689
Name:SHARP, COTRENA D
Entity type:Individual
Prefix:
First Name:COTRENA
Middle Name:D
Last Name:SHARP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 FERNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-7171
Mailing Address - Country:US
Mailing Address - Phone:901-591-3090
Mailing Address - Fax:
Practice Address - Street 1:490 FERNWOOD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-7171
Practice Address - Country:US
Practice Address - Phone:901-591-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)