Healthcare Provider Details

I. General information

NPI: 1801807615
Provider Name (Legal Business Name): SHARON AGNES SCHLICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E ASH ST
PERRY FL
32347
US

IV. Provider business mailing address

315 E ASH ST
PERRY FL
32347
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-3278
  • Fax: 850-584-8171
Mailing address:
  • Phone: 850-584-3278
  • Fax: 850-584-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: