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General NPI Number Information
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NPI Number | 1063195253
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Entity Type | Individual
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Provider Name | SHARISSE LIN IVORY APRN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 835 OAKLEY SEAVER DR
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City | CLERMONT
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State | FL
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Zip | 34711-1968
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Country | US
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Telephone | 352-241-9282
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Fax | 352-241-4282
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Provider Business Mailing Address
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Address Line | 835 OAKLEY SEAVER DR
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City | CLERMONT
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State | FL
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Zip | 34711-1968
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Country | US
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Telephone | 352-241-9282
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Fax | 352-241-4282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11028060
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License Number State | FL
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