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NPI Code Detail

MEDICARE: MR. OCTAVIAN SHARP FNP

MEDICARE: MR. OCTAVIAN SHARP 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
1363LF0000XFamily Nurse Practitioner0000015059TN
2363LF0000XFamily Nurse PractitionerA810365MS
3363LF0000XFamily Nurse PractitionerAPN15059TN

Other Identifiers

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

General Provider Information

NPI Number : 1184938201
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OCTAVIAN SHARP FNP
Provider Business Mailing Address
First Line : PO BOX 746725
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6725
Country : US
Telephone Number : 601-533-7017
Fax Number : 601-553-7016
Provider Business Practice Location Address
First Line : 5339 ELVIS PRESLEY BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38116-8243
Country : US
Telephone Number : 901-504-7002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2010
Last Update Date : 04/18/2025

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