MEDICARE: MRS. SHARICA PENNINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9542753	FL

General Provider Information

NPI Number	:	1003577107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARICA PENNINGTON

Provider Business Mailing Address
First Line	:	1775 N MARKLEY CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-2304
Country	:	US
Telephone Number	:	239-317-5259
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 N MARKLEY CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-2304
Country	:	US
Telephone Number	:	239-317-5259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	01/02/2022

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Directions to “ MRS. SHARICA PENNINGTON ” Practice Location

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