Provider Demographics
NPI:1639855562
Name:ADRADOS, SARA (DNP, ARNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ADRADOS
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903
Mailing Address - Country:US
Mailing Address - Phone:321-917-5549
Mailing Address - Fax:
Practice Address - Street 1:200 S HARBOR CITY BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1389
Practice Address - Country:US
Practice Address - Phone:321-917-5549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027170363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health