Provider Demographics
NPI:1578573036
Name:HORRAS, SARA J (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:HORRAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 TUTTLE ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1501
Mailing Address - Country:US
Mailing Address - Phone:608-355-2033
Mailing Address - Fax:608-355-6810
Practice Address - Street 1:1626 TUTTLE ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1501
Practice Address - Country:US
Practice Address - Phone:608-355-2033
Practice Address - Fax:608-355-6810
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1578573036Medicaid
TXQ77880Medicare UPIN
TX8J3619Medicare ID - Type Unspecified