Provider Demographics
NPI:1407257827
Name:JUSTICE, SARA (NP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JUSTICE
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 1:403 W SIMCOE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-5829
Mailing Address - Country:US
Mailing Address - Phone:337-534-8242
Mailing Address - Fax:337-534-8243
Practice Address - Street 1:403 W SIMCOE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-5829
Practice Address - Country:US
Practice Address - Phone:337-534-8242
Practice Address - Fax:337-534-8243
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily