Provider Demographics
NPI:1972108199
Name:CARBULLIDO, SARAH LYNN (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH LYNN
Middle Name:
Last Name:CARBULLIDO
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 HARBOUR VIEW BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2663
Mailing Address - Country:US
Mailing Address - Phone:757-483-3030
Mailing Address - Fax:
Practice Address - Street 1:5838 HARBOUR VIEW BLVD STE 240
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2663
Practice Address - Country:US
Practice Address - Phone:757-483-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001303209OtherREGISTERED NURSE
VA0024182191OtherNURSE PRACTITIONER LICENSE