Provider Demographics
NPI:1407054307
Name:KLINTWORTH, SARA ELIZABETH (CNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH
Last Name:KLINTWORTH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7326 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9709
Mailing Address - Country:US
Mailing Address - Phone:330-806-6062
Mailing Address - Fax:
Practice Address - Street 1:3562 RIDGE PARK DR STE D1
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9294
Practice Address - Country:US
Practice Address - Phone:330-664-1670
Practice Address - Fax:330-664-1675
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2019-12-16
Deactivation Date:2018-10-17
Deactivation Code:
Reactivation Date:2018-10-31
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily