Provider Demographics
NPI:1760130231
Name:PULICE, SARAH GALANTI (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GALANTI
Last Name:PULICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:DANIELLE
Other - Last Name:GALANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:110 BASSETT HALL CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-8705
Mailing Address - Country:US
Mailing Address - Phone:520-909-8749
Mailing Address - Fax:
Practice Address - Street 1:4230 HARDING PIKE STE 1000
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2098
Practice Address - Country:US
Practice Address - Phone:615-913-5812
Practice Address - Fax:615-292-9469
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ073408Medicaid