Healthcare Provider Details

I. General information

NPI: 1114968724
Provider Name (Legal Business Name): SHARON L BURT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4306
US

IV. Provider business mailing address

39 PARK LN
GLEN MILLS PA
19342-1126
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-4339
  • Fax: 215-590-4334
Mailing address:
  • Phone: 610-459-5952
  • Fax: 215-590-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP008437
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberSP008437
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: