Provider Demographics
NPI:1215230446
Name:CANCHOLA, SARA BROOKE (APRN)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:BROOKE
Last Name:CANCHOLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4010 DUPONT CIR STE L07
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4812
Mailing Address - Country:US
Mailing Address - Phone:502-895-6559
Mailing Address - Fax:502-895-8994
Practice Address - Street 1:4010 DUPONT CIR STE L07
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-895-6559
Practice Address - Fax:502-895-8994
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3006713363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health