MEDICARE: MRS. SHERRI ANNETTE D'AGATA ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2841952	FL

General Provider Information

NPI Number	:	1023385515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRI ANNETTE D'AGATA ARNP

Provider Business Mailing Address
First Line	:	3472 BABICHE STREET
Second Line	:
City	:	ST. JOHNS
State	:	FL
Zip	:	32259-2196
Country	:	US
Telephone Number	:	904-228-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3472 BABICHE ST
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-2196
Country	:	US
Telephone Number	:	904-228-5333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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