Provider Demographics
NPI:1790477628
Name:SMITH, SHARON ANISE (APRN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E 86TH CT STE D
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6259
Mailing Address - Country:US
Mailing Address - Phone:219-242-7822
Mailing Address - Fax:219-803-1404
Practice Address - Street 1:209 E 86TH CT STE D
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6259
Practice Address - Country:US
Practice Address - Phone:219-242-7822
Practice Address - Fax:219-803-1404
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2025-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11038858363LA2200X
IN28251057A163WG0000X
IN71013963A363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily