Healthcare Provider Details

I. General information

NPI: 1134274194
Provider Name (Legal Business Name): CHARLES RODNEY SHARPE II APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/15/2024
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 E PARKSIDE LN
PHOENIX AZ
85024-7575
US

IV. Provider business mailing address

2527 E PARKSIDE LN
PHOENIX AZ
85024-7575
US

V. Phone/Fax

Practice location:
  • Phone: 480-910-4160
  • Fax: 480-546-3203
Mailing address:
  • Phone: 480-910-4160
  • Fax: 480-546-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number247414
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN207955
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: