Provider Demographics
NPI:1629247796
Name:HARTMAN, SARA LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNNE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 E BELL RD STE 125
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2238
Mailing Address - Country:US
Mailing Address - Phone:602-971-0268
Mailing Address - Fax:602-971-1556
Practice Address - Street 1:4045 E BELL RD STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2238
Practice Address - Country:US
Practice Address - Phone:602-971-0268
Practice Address - Fax:602-971-1556
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant