Organization
BLACKSHEEP MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WHITNEY CHARISMA ARNP (OWNER / PROVIDER)
(407) 900-1394
Entity
Organization
Contact information
Practice address
1120 LEXINGTON GREEN LN STE A, SANFORD, FL 32771-1022
(407) 900-1394
Mailing address
PO BOX 522691, LONGWOOD, FL 32752-2691
(386) 402-1892
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103694100
—
FL
Enumeration date
08/24/2023
Last updated
08/24/2023
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