Provider Demographics
NPI:1548207335
Name:WISHART, SHARINE T (APRN)
Entity type:Individual
Prefix:MISS
First Name:SHARINE
Middle Name:T
Last Name:WISHART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1032 E BRANDON BLVD STE 4567
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5509
Mailing Address - Country:US
Mailing Address - Phone:201-474-5844
Mailing Address - Fax:877-804-1324
Practice Address - Street 1:1516 E COLONIAL DR STE 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4726
Practice Address - Country:US
Practice Address - Phone:407-419-0794
Practice Address - Fax:407-557-4832
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3253512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307662800Medicaid
FL01223409OtherAMERIGROUP
FL465046OtherWELLCARE
FLDO635ZMedicare UPIN