Provider Demographics
NPI:1528050788
Name:AZAR, SHERRY D (APRN)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:D
Last Name:AZAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9776 BONITA BEACH RD SE STE 201A
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4775
Mailing Address - Country:US
Mailing Address - Phone:239-947-3092
Mailing Address - Fax:239-949-2174
Practice Address - Street 1:9776 BONITA BEACH RD SE STE 201A
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4775
Practice Address - Country:US
Practice Address - Phone:239-947-3092
Practice Address - Fax:239-947-5298
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10457363LF0000X
FLAPRN9493687363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3649406Medicaid
TN3649406Medicare ID - Type UnspecifiedMEDICARE, CIGNA, PART B
TN3649406Medicaid