Basic Information
Provider Information | |||||||||
NPI: | 1962462895 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHARP | ||||||||
FirstName: | BARBARA | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3599 UNIVERSITY BLVD S | ||||||||
Address2: | BUILDING 300 | ||||||||
City: | JACKSONVILLE | ||||||||
State: | FL | ||||||||
PostalCode: | 322164252 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9043995550 | ||||||||
FaxNumber: | 9043464334 | ||||||||
Practice Location | |||||||||
Address1: | 3599 UNIVERSITY BLVD S | ||||||||
Address2: | BUILDING 300 | ||||||||
City: | JACKSONVILLE | ||||||||
State: | FL | ||||||||
PostalCode: | 322164252 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9043995550 | ||||||||
FaxNumber: | 9043464334 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/24/2006 | ||||||||
LastUpdateDate: | 03/17/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | ME53435 | FL | N |   | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | ME53435 | FL | N |   | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | ME53435 | FL | N |   | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | ME53435 | FL | N |   | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | ME53435 | FL | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | ME53435 | FL | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | ME53435 | FL | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
ID | Type | State | Issuer | Description | 00373337A | 05 | GA |   | MEDICAID | 07218 | 01 | FL | BCBS | OTHER | 047083000 | 05 | FL |   | MEDICAID |