MEDICARE: MRS. SHARON WOLF LPN

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	164W00000X	Licensed Practical Nurse	5201653	FL

General Provider Information

NPI Number	:	1336698760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON WOLF LPN

Provider Business Mailing Address
First Line	:	8100 BRIGHTON DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6240
Country	:	US
Telephone Number	:	727-992-0659
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 BRIGHTON DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6240
Country	:	US
Telephone Number	:	727-992-0659
Fax Number	:

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

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	03/15/2019

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