Provider Demographics
NPI:1326408386
Name:LARA, SARA (NP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:NP-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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7120
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3980 HIGHWAY 9 E STE 340
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8165
Practice Address - Country:US
Practice Address - Phone:843-390-8302
Practice Address - Fax:843-390-8315
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4304Medicaid