Provider Demographics
NPI:1922007442
Name:COMBS, SARA K (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:K
Last Name:COMBS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:K
Other - Last Name:CANADAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:GLEN ST MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-0606
Mailing Address - Country:US
Mailing Address - Phone:904-653-1818
Mailing Address - Fax:904-653-1814
Practice Address - Street 1:6704 E MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:GLEN ST MARY
Practice Address - State:FL
Practice Address - Zip Code:32040-5050
Practice Address - Country:US
Practice Address - Phone:904-259-7420
Practice Address - Fax:904-259-8366
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3208602363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306014400Medicaid