Provider Demographics
NPI:1013675800
Name:JUDAH, SARAH JEAN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:JUDAH
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 1:1018 BUENA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2157
Mailing Address - Country:US
Mailing Address - Phone:850-348-2757
Mailing Address - Fax:
Practice Address - Street 1:521 N GRAY AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-5203
Practice Address - Country:US
Practice Address - Phone:850-276-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider