Provider Demographics
NPI:1164826012
Name:HORMIG, SARA ANNE (APN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:HORMIG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANNE
Other - Last Name:HOERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3475 S ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-2604
Mailing Address - Country:US
Mailing Address - Phone:815-874-8000
Mailing Address - Fax:
Practice Address - Street 1:PHYSICIANS IMMEDIATE CARE
Practice Address - Street 2:3475 S ALPIND RD.
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-2604
Practice Address - Country:US
Practice Address - Phone:815-874-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI145470-30163W00000X
IL041.265949163W00000X
WI6155-33363L00000X
IL277000205363L00000X
IL277.000205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse