Provider Demographics
NPI:1316719065
Name:SHARPE, TYRA DENISE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:TYRA
Middle Name:DENISE
Last Name:SHARPE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16412 EASTBURN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1529
Mailing Address - Country:US
Mailing Address - Phone:313-215-4979
Mailing Address - Fax:
Practice Address - Street 1:16412 EASTBURN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1529
Practice Address - Country:US
Practice Address - Phone:313-215-4979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704384611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse