Healthcare Provider Details

I. General information

NPI: 1033189204
Provider Name (Legal Business Name): JOLENE J. SHARRETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE, ATTN: CREDENTIALS OFFICE
FORT CARSON CO
80913-4604
US

IV. Provider business mailing address

902 TARI DR
COLORADO SPRINGS CO
80921-2255
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7844
  • Fax: 719-526-7984
Mailing address:
  • Phone: 719-488-5868
  • Fax: 719-488-5869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number114234
License Number StateCO

VIII. Authorized Official

Name: MRS. JOLENE J. SHARRETT
Title or Position: OB/GYN NURSE PRACTITIONER
Credential: NURSE PRACTITIONER
Phone: 719-524-4773