Provider Demographics
NPI:1548500937
Name:LEE, SHERRY DENISE (CRNA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:DENISE
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:DENISE
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:DEPT. 892
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0892
Mailing Address - Country:US
Mailing Address - Phone:904-859-5518
Mailing Address - Fax:904-551-3265
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-859-5518
Practice Address - Fax:904-551-3265
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9263091367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003131662AMedicaid
FL008294200Medicaid
FLP01393220Medicare PIN
FL008294200Medicaid