Healthcare Provider Details

I. General information

NPI: 1760460042
Provider Name (Legal Business Name): SHERYL FAIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4562 E HIGHWAY 20
NICEVILLE FL
32578-8831
US

IV. Provider business mailing address

4562 E HIGHWAY 20
NICEVILLE FL
32578-8831
US

V. Phone/Fax

Practice location:
  • Phone: 334-832-4338
  • Fax: 334-832-9971
Mailing address:
  • Phone: 334-263-2301
  • Fax: 334-263-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-037805
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9397231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: