Provider Demographics
NPI:1447664743
Name:SHARON, TONI DENEICE (FNP-C)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:DENEICE
Last Name:SHARON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 ROSE LN STE A
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1448
Mailing Address - Country:US
Mailing Address - Phone:286-681-8389
Mailing Address - Fax:
Practice Address - Street 1:519 ROSE LN STE A
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1448
Practice Address - Country:US
Practice Address - Phone:928-668-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN144335163W00000X
AZAP5653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ921974Medicaid