Provider Demographics
NPI:1164168951
Name:ROSS, SARAH RAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RAE
Last Name:ROSS
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 1:3400 SW HIGHWAY 361
Mailing Address - Street 2:
Mailing Address - City:STEINHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32359-5306
Mailing Address - Country:US
Mailing Address - Phone:352-949-7811
Mailing Address - Fax:
Practice Address - Street 1:3400 SW HIGHWAY 361
Practice Address - Street 2:
Practice Address - City:STEINHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:32359-5306
Practice Address - Country:US
Practice Address - Phone:352-949-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine