Provider Demographics
NPI:1699828343
Name:RICCI, SARA ANNE (PNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:RICCI
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 CORINTHIAN AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-1121
Mailing Address - Country:US
Mailing Address - Phone:215-939-4447
Mailing Address - Fax:
Practice Address - Street 1:34TH ST AND CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-1719
Practice Address - Fax:215-590-2223
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009222363LP0200X
NJ26NJ00158200363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics