Provider Demographics
NPI:1538907753
Name:ETIENNE, SHERLINE (RN)
Entity type:Individual
Prefix:
First Name:SHERLINE
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 TREESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-4973
Mailing Address - Country:US
Mailing Address - Phone:813-475-1763
Mailing Address - Fax:
Practice Address - Street 1:2225 TREESDALE AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4973
Practice Address - Country:US
Practice Address - Phone:813-475-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9450166163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice