MEDICARE: SHARON AMY GORETSKY FNP

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	363L00000X	Nurse Practitioner	0017139135	VA

General Provider Information

NPI Number	:	1093974214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON AMY GORETSKY FNP

Provider Business Mailing Address
First Line	:	6025 PROVIDENCE RD
Second Line	:	SUITE 110
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3808
Country	:	US
Telephone Number	:	757-474-0600
Fax Number	:	757-474-1903

Provider Business Practice Location Address
First Line	:	6025 PROVIDENCE RD
Second Line	:	SUITE 110
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3808
Country	:	US
Telephone Number	:	757-474-0600
Fax Number	:	757-474-1903

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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