Provider Demographics
NPI:1730730326
Name:HAMILTON DAVIS, SHAREEFAH MARIE (DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:SHAREEFAH
Middle Name:MARIE
Last Name:HAMILTON DAVIS
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6350
Mailing Address - Country:US
Mailing Address - Phone:352-431-3940
Mailing Address - Fax:352-431-3173
Practice Address - Street 1:2753 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6699
Practice Address - Country:US
Practice Address - Phone:352-431-3940
Practice Address - Fax:352-431-3173
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005230163WP0808X
FL11005230363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health