Provider Demographics
NPI:1144797366
Name:ROTHE, SARA (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ROTHE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:129 E REDSTONE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5350
Mailing Address - Country:US
Mailing Address - Phone:850-682-7212
Mailing Address - Fax:850-682-0220
Practice Address - Street 1:514 MARY ESTHER CUT OFF NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4047
Practice Address - Country:US
Practice Address - Phone:850-226-8550
Practice Address - Fax:850-226-6712
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2021-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant