Provider Demographics
NPI:1790242121
Name:ROSEBAUGH, SARA A (CNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:ROSEBAUGH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 COMMUNITY RD STE C
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2358
Mailing Address - Country:US
Mailing Address - Phone:330-633-6601
Mailing Address - Fax:
Practice Address - Street 1:65 COMMUNITY RD STE C
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2358
Practice Address - Country:US
Practice Address - Phone:330-633-6601
Practice Address - Fax:330-644-9815
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024283363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner