MEDICARE: SHERRI ANN ROBERTS PA-C

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	363AS0400X	Surgical Physician Assistant	PA9103186	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00232772	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124022975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRI ANN ROBERTS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP - PROVIDER ENROLLMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-3199
Fax Number	:	904-244-3425

Provider Business Practice Location Address
First Line	:	655 W 8TH ST
Second Line	:	UFJAX - DEPT. OF EMERGENCY MEDICINE
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-5044
Fax Number	:	904-244-5666

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	11/24/2014

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Directions to “ SHERRI ANN ROBERTS PA-C” Practice Location

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