Provider Demographics
NPI:1245908052
Name:ROACH, SARAH ELIZABETH (MS, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:ROACH
Suffix:
Gender:F
Credentials:MS, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CAYUGA PARK LN STE 201
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1180
Mailing Address - Country:US
Mailing Address - Phone:607-277-4341
Mailing Address - Fax:607-216-0918
Practice Address - Street 1:401 CAYUGA PARK LN STE 201
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1180
Practice Address - Country:US
Practice Address - Phone:607-277-4341
Practice Address - Fax:607-216-0918
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY854538163W00000X
NY350479363LF0000X, 363LF0000X
OHAPRN.CNP.0029690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse