Provider Demographics
NPI:1831485390
Name:ANDERSON, SARAH ELIZABETH (NP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9033
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-9033
Mailing Address - Country:US
Mailing Address - Phone:772-287-5200
Mailing Address - Fax:772-223-5622
Practice Address - Street 1:10080 SW INNOVATION WAY STE 103
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2129
Practice Address - Country:US
Practice Address - Phone:772-223-5903
Practice Address - Fax:772-223-5914
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1215204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003881400Medicaid
FLY08NFOtherFL BLUE
FLY08NFOtherFL BLUE