Provider Demographics
NPI:1760725956
Name:WILDE, SARAH PAIGE (AP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:PAIGE
Last Name:WILDE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3373 PINTAIL DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3041
Mailing Address - Country:US
Mailing Address - Phone:904-651-0940
Mailing Address - Fax:
Practice Address - Street 1:2850 ISABELLA BLVD STE 50
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8004
Practice Address - Country:US
Practice Address - Phone:904-651-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3056171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist