Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 3140902 | FL |
NPI | 1003818832 |
---|---|
Provider Name | Ms. Susan Ann Sherman |
First Address | Cape Coral, FL 33909-4303 |
Second Address | Fort Myers, FL 33901-8193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 08/07/2007 |