Provider Demographics
NPI:1770929994
Name:DRISDOM, SHERONDA DENISE (MSN, ARNP, AOCNP)
Entity type:Individual
Prefix:
First Name:SHERONDA
Middle Name:DENISE
Last Name:DRISDOM
Suffix:
Gender:F
Credentials:MSN, ARNP, AOCNP
Other - Prefix:
Other - First Name:SHERONDA
Other - Middle Name:DENISE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:3730 7TH TERRACE
Practice Address - Street 2:SUITE 101
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6556
Practice Address - Country:US
Practice Address - Phone:772-581-0528
Practice Address - Fax:772-581-0535
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9185762363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017341700Medicaid
FLID671YMedicare PIN