Provider Demographics
NPI:1861840670
Name:COPELAND, SARA BRALEY (DNP, ARNP, IBCLC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:BRALEY
Last Name:COPELAND
Suffix:
Gender:F
Credentials:DNP, ARNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SW 130TH WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-0015
Mailing Address - Country:US
Mailing Address - Phone:352-733-7337
Mailing Address - Fax:352-672-4567
Practice Address - Street 1:133 SW 130TH WAY
Practice Address - Street 2:SUITE C
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-0015
Practice Address - Country:US
Practice Address - Phone:352-733-7337
Practice Address - Fax:352-672-4567
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9354909363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018206800Medicaid
FLIR177ZMedicare PIN