Provider Demographics
NPI:1982210282
Name:HODGE, SARA ELIZABETH
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16532 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-6185
Mailing Address - Country:US
Mailing Address - Phone:731-300-7755
Mailing Address - Fax:731-300-0773
Practice Address - Street 1:1385 S HIGHLAND AVE STE B4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7547
Practice Address - Country:US
Practice Address - Phone:731-300-7755
Practice Address - Fax:731-300-0773
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29075363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program