Provider Demographics
NPI:1548593817
Name:MCGUIRE, SARAH (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 HEAVENS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2804
Mailing Address - Country:US
Mailing Address - Phone:504-934-8320
Mailing Address - Fax:
Practice Address - Street 1:15276A DEDEAUX RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3161
Practice Address - Country:US
Practice Address - Phone:225-772-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA703955901363LF0000X
MSR895953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01074272Medicaid
LA1817180Medicaid
LA1817180Medicaid
3B796CW42Medicare PIN
MS01074272Medicaid