Healthcare Provider Details

I. General information

NPI: 1528050788
Provider Name (Legal Business Name): SHERRY D AZAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11241 MIROMAR SQUARE BLVD
ESTERO FL
33928-6229
US

IV. Provider business mailing address

11241 MIROMAR SQUARE BLVD
ESTERO FL
33928-6229
US

V. Phone/Fax

Practice location:
  • Phone: 239-992-6168
  • Fax: 239-498-6622
Mailing address:
  • Phone: 239-992-6168
  • Fax: 239-498-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9493687
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10457
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: