Healthcare Provider Details

I. General information

NPI: 1306848874
Provider Name (Legal Business Name): SHERRY T WARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRY TILLMAN WARD ARNP, APRN

II. Dates (important events)

Enumeration Date: 08/13/2005
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12598 EMERALD COAST PKWY W UNIT 101
MIRAMAR BEACH FL
32550-2102
US

IV. Provider business mailing address

PO BOX 6984
MIRAMAR BEACH FL
32550-1018
US

V. Phone/Fax

Practice location:
  • Phone: 850-654-8878
  • Fax:
Mailing address:
  • Phone: 850-837-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN073715 NP
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 2714622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: