Provider Demographics
NPI:1407113194
Name:CARPENTER, SARA JEANNE (PAC)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JEANNE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7175 E CAMELBACK RD
Mailing Address - Street 2:803
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1201
Mailing Address - Country:US
Mailing Address - Phone:410-703-1531
Mailing Address - Fax:
Practice Address - Street 1:535 E MCKELLIPS RD
Practice Address - Street 2:STE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2522
Practice Address - Country:US
Practice Address - Phone:480-320-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5176363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical