Provider Demographics
NPI:1831960012
Name:HALL, SHERRY LIENASE (OWNER)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LIENASE
Last Name:HALL
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6658 HATCHER RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2269
Mailing Address - Country:US
Mailing Address - Phone:863-698-2582
Mailing Address - Fax:
Practice Address - Street 1:6658 HATCHER RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2269
Practice Address - Country:US
Practice Address - Phone:863-698-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN-9550626163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health