Provider Demographics
NPI:1710402243
Name:SAXTON, SARA R (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:SAXTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 IRVING AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1663
Mailing Address - Country:US
Mailing Address - Phone:315-470-7409
Mailing Address - Fax:315-475-2357
Practice Address - Street 1:739 IRVING AVE STE 600
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-470-7409
Practice Address - Fax:315-475-2357
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343685-1363L00000X
VA0024175083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024175083OtherVIRGINIA BOARD OF NURSING
VA0017144117OtherCOMMONWEALTH OF VIRGINIA BOARD OF NURSING