Healthcare Provider Details

I. General information

NPI: 1720900061
Provider Name (Legal Business Name): SHARA HEATHER BROWN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 THUNDER RD STE 130
ELIZABETH CITY NC
27909-7710
US

IV. Provider business mailing address

905 THUNDER RD STE 130
ELIZABETH CITY NC
27909-7710
US

V. Phone/Fax

Practice location:
  • Phone: 252-384-0600
  • Fax: 844-494-0227
Mailing address:
  • Phone: 252-384-0600
  • Fax: 844-494-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5025069
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5025069
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: