Provider Demographics
NPI:1780661512
Name:PUITA, SHARON L (RN ANP-C)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:PUITA
Suffix:
Gender:F
Credentials:RN ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1428 PHILLIPS LN
Mailing Address - Street 2:203
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2537
Mailing Address - Country:US
Mailing Address - Phone:805-543-4407
Mailing Address - Fax:805-543-4587
Practice Address - Street 1:1428 PHILLIPS LN
Practice Address - Street 2:203
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2537
Practice Address - Country:US
Practice Address - Phone:805-543-4407
Practice Address - Fax:805-543-4587
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456921163W00000X
CA14148363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q48577Medicare UPIN
WNP14148AMedicare ID - Type Unspecified