Provider Demographics
NPI:1992743256
Name:WALTER, SHARON (CRNA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:RAVELL
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:3058 WYNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-4744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1874 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5545
Practice Address - Country:US
Practice Address - Phone:772-337-7676
Practice Address - Fax:772-337-9034
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2584372367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306173600Medicaid
FLG1638OtherBCBS OF FLORIDA
FL430032474OtherRR MEDICARE
FLG1638WMedicare PIN