Provider Demographics
NPI:1659868123
Name:COOPER, SARAH ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:COOPER
Other - Last Name:LIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:812 HOGENSBORG
Mailing Address - Street 2:
Mailing Address - City:FREDERIKSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00840-4455
Mailing Address - Country:US
Mailing Address - Phone:804-514-9255
Mailing Address - Fax:
Practice Address - Street 1:5030 ANCHOR WAY STE 9&10
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4692
Practice Address - Country:US
Practice Address - Phone:340-719-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VI077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program