Provider Demographics
NPI:1225597727
Name:INGRAM, SARA DYANE (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DYANE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:DNP, 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:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-0021
Mailing Address - Country:US
Mailing Address - Phone:602-373-0932
Mailing Address - Fax:
Practice Address - Street 1:1300 S LITCHFIELD RD STE 210I
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1583
Practice Address - Country:US
Practice Address - Phone:623-248-0297
Practice Address - Fax:623-248-0299
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN156316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner