Provider Demographics
NPI:1831653468
Name:NOTMAN-MICHEL, SARA VICTORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:VICTORIA
Last Name:NOTMAN-MICHEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 NW LAKE WHITNEY PL
Mailing Address - Street 2:STE 105
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1628
Mailing Address - Country:US
Mailing Address - Phone:772-785-5864
Mailing Address - Fax:
Practice Address - Street 1:573 NW LAKE WHITNEY PL STE 105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1628
Practice Address - Country:US
Practice Address - Phone:772-785-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111936363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184824542Medicaid