Provider Demographics
NPI:1588210215
Name:GOUJON, SARAH R (ACNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:GOUJON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ROTELLA
Other - Last Name:GOUJON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNP
Mailing Address - Street 1:1031 LOFTIS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2981
Mailing Address - Country:US
Mailing Address - Phone:757-736-9850
Mailing Address - Fax:
Practice Address - Street 1:1031 LOFTIS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2981
Practice Address - Country:US
Practice Address - Phone:757-736-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431602363LA2100X
VA0024186841363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care