Provider Demographics
NPI:1215268990
Name:SHERIDAN, TRISHA GAIL (WHNP-BC)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:GAIL
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 AVENUE I STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5831
Mailing Address - Country:US
Mailing Address - Phone:936-295-6396
Mailing Address - Fax:936-295-6396
Practice Address - Street 1:2405 AVENUE I STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5831
Practice Address - Country:US
Practice Address - Phone:936-295-6396
Practice Address - Fax:936-295-6396
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX791838363LW0102X
WAAP60116159363LW0102X
NY42 420956363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health