Provider Demographics
NPI:1790036689
Name:DAVIS, SHARON RENAE (FNP - BC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:RENAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP - BC
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:RENAE
Other - Last Name:ATKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18440 W WIND SONG AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2629
Mailing Address - Country:US
Mailing Address - Phone:801-450-8403
Mailing Address - Fax:
Practice Address - Street 1:18440 W WIND SONG AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2629
Practice Address - Country:US
Practice Address - Phone:801-450-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ316758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner