Healthcare Provider Details

I. General information

NPI: 1134539125
Provider Name (Legal Business Name): SHARON DENISE RUDOLPH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON D RUFFIN ARNP

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 CORTEZ RD W
BRADENTON FL
34210-3142
US

IV. Provider business mailing address

PO BOX 25487
SARASOTA FL
34277-2487
US

V. Phone/Fax

Practice location:
  • Phone: 941-357-5550
  • Fax: 941-792-7152
Mailing address:
  • Phone: 941-202-5342
  • Fax: 855-253-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18646
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2074876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: