Healthcare Provider Details

I. General information

NPI: 1912914789
Provider Name (Legal Business Name): SHAROEN E KLINE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8777 SW 15TH AVE
GAINESVILLE FL
32607-4989
US

IV. Provider business mailing address

8777 SW 15TH AVE
GAINESVILLE FL
32607-4989
US

V. Phone/Fax

Practice location:
  • Phone: 352-262-3812
  • Fax: 352-373-2544
Mailing address:
  • Phone: 352-379-4154
  • Fax: 352-374-6103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2544972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: