Provider Demographics
NPI:1891176533
Name:MOSS, SARA L (AG-ACNP-BC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:MOSS
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:GANIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AG-ACNP-BC
Mailing Address - Street 1:13677 W MCDOWELL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2635
Mailing Address - Country:US
Mailing Address - Phone:623-536-4200
Mailing Address - Fax:623-935-0304
Practice Address - Street 1:13677 W MCDOWELL RD STE 201
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2635
Practice Address - Country:US
Practice Address - Phone:623-536-4200
Practice Address - Fax:623-935-0304
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7893363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZNPIOtherNPI 1891176533