Provider Demographics
NPI:1275957763
Name:TAPPAN, SARA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:TAPPAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 FLOYD PL
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1312
Mailing Address - Country:US
Mailing Address - Phone:516-417-6814
Mailing Address - Fax:
Practice Address - Street 1:62 FLOYD PL
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1312
Practice Address - Country:US
Practice Address - Phone:516-417-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306545-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health