Healthcare Provider Details

I. General information

NPI: 1760471510
Provider Name (Legal Business Name): SHARON K HERNLY RN, MSN, ANP, CGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18731 N REEMS RD #680
SURPRISE AZ
85374
US

IV. Provider business mailing address

13634 N 93RD AVE #100
PEORIA AZ
85381
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-0592
  • Fax: 623-975-0750
Mailing address:
  • Phone: 623-933-0301
  • Fax: 623-933-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN098246
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRN098246
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: