MEDICARE: MS. SHERRY GARDNER THOMPSON LCSW, RN

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	1041C0700X	Clinical Social Worker	SW769	FL
2	163W00000X	Registered Nurse	RN1261672	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN1261672	OTHER	FL	REGISTERED NURSE
2	SW769	OTHER	FL	LIC. CLINICAL SOC. WORKER

General Provider Information

NPI Number	:	1770551186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERRY GARDNER THOMPSON LCSW, RN

Provider Business Mailing Address
First Line	:	7543 N LEEWYNN DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-8793
Country	:	US
Telephone Number	:	941-371-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 17TH ST
Second Line	:	J2
City	:	SARASOTA
State	:	FL
Zip	:	34234-8632
Country	:	US
Telephone Number	:	941-552-2075
Fax Number	:	941-552-2079

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/20/2011

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