Provider Demographics
NPI:1104140672
Name:NOLES, SHARON B (RN, RRT, LMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:B
Last Name:NOLES
Suffix:
Gender:F
Credentials:RN, RRT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 KIMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4408
Mailing Address - Country:US
Mailing Address - Phone:352-422-7853
Mailing Address - Fax:
Practice Address - Street 1:855 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4415
Practice Address - Country:US
Practice Address - Phone:352-422-7853
Practice Address - Fax:352-794-3234
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist