Provider Demographics
NPI:1376623603
Name:WYATT, SABRINA NOEL (MD)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:NOEL
Last Name:WYATT
Suffix:
Gender:F
Credentials:MD
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 100294
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0294
Mailing Address - Country:US
Mailing Address - Phone:352-273-7584
Mailing Address - Fax:352-392-3498
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-5417
Practice Address - Country:US
Practice Address - Phone:352-265-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40334207V00000X
AL31284207V00000X
FLME164576207V00000X
OK31931207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051121387OtherBCBS
AL051121389OtherBCBS
AL134854Medicaid
AL135207Medicaid
ALZ50053OtherVIVA
AL051121388OtherBCBS
AL134905Medicaid
MS01128737Medicaid
AL051121386OtherBCBS
AL134833Medicaid
AL102I164727Medicare PIN