Provider Demographics
NPI:1184031775
Name:REEVES, SARAH-JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH-JEAN
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 NW 86TH TER
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-9277
Mailing Address - Country:US
Mailing Address - Phone:352-265-0820
Mailing Address - Fax:
Practice Address - Street 1:4037 NW 86TH TER
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-9277
Practice Address - Country:US
Practice Address - Phone:352-265-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012694900Medicaid
FLHW658ZMedicare PIN