Provider Demographics
NPI:1477866838
Name:BEAUCHAMP, SARA E (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:ALMENDAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4451
Mailing Address - Fax:970-490-4199
Practice Address - Street 1:5818 N NEVADA AVE STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3505
Practice Address - Country:US
Practice Address - Phone:719-365-1950
Practice Address - Fax:719-364-0022
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06821363A00000X
COPA.0004745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142872Medicaid
TX9910589OtherAETNA