Healthcare Provider Details

I. General information

NPI: 1851982953
Provider Name (Legal Business Name): DESTINY ELIA SHARP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 09/06/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 N WILLIAMS ST STE 108
DUNNELLON FL
34432-8364
US

IV. Provider business mailing address

11150 N WILLIAMS ST STE 108
DUNNELLON FL
34432-8364
US

V. Phone/Fax

Practice location:
  • Phone: 352-423-9899
  • Fax:
Mailing address:
  • Phone: 352-423-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11011378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: