Provider Demographics
NPI:1104964824
Name:HACKLEY, SHARON UNGAR (CRNA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:UNGAR
Last Name:HACKLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NOB AVE
Mailing Address - Street 2:AV
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3316
Mailing Address - Country:US
Mailing Address - Phone:858-793-0336
Mailing Address - Fax:
Practice Address - Street 1:101 NOB AVE
Practice Address - Street 2:AV
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3316
Practice Address - Country:US
Practice Address - Phone:858-793-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN2171367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered