Healthcare Provider Details

I. General information

NPI: 1487621314
Provider Name (Legal Business Name): SHERI S SMALL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 LAKELAND HILLS BLVD
LAKELAND FL
33805-3016
US

IV. Provider business mailing address

13110 ELK MOUNTAIN DR
RIVERVIEW FL
33579-7182
US

V. Phone/Fax

Practice location:
  • Phone: 863-940-2908
  • Fax: 863-940-4722
Mailing address:
  • Phone: 813-349-7568
  • Fax: 813-349-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP3196352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: