Provider Demographics
NPI:1033711031
Name:MOODY, SARAH DENISE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DENISE
Last Name:MOODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:DENISE
Other - Last Name:BOOTENHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4910 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8972
Mailing Address - Country:US
Mailing Address - Phone:850-494-4600
Mailing Address - Fax:850-433-8940
Practice Address - Street 1:4910 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8972
Practice Address - Country:US
Practice Address - Phone:850-494-4600
Practice Address - Fax:850-433-8940
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1118947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily