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General NPI Number Information
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NPI Number | 1659949683
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Entity Type | Organization
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Legal Business Name | PROCARE NP ECLINIC, LLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 1309 COFFEEN AVE STE 1200
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone | 307-461-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 9998 EAGLE CREEK CENTER BLVD
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City | ORLANDO
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State | FL
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Zip | 32832-6333
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SHARANNA SHARMEL JOHNSON
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Credential | FNP
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Telephone | 321-343-7008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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