Healthcare Provider Details

I. General information

NPI: 1275459422
Provider Name (Legal Business Name): DIANA SHARP APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 FRONT ST
ELMER NJ
08318-2157
US

IV. Provider business mailing address

7 JACK ROBERT DR
BRIDGETON NJ
08302-6059
US

V. Phone/Fax

Practice location:
  • Phone: 856-358-5050
  • Fax:
Mailing address:
  • Phone: 856-300-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15535200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: