Provider Demographics
NPI:1255714499
Name:BRUNNER, SARAH (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:865 EASTON RD STE 150
Practice Address - Street 2:HERITAGE WARRINGTON CENTER
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-7800
Practice Address - Country:US
Practice Address - Phone:215-343-5900
Practice Address - Fax:215-343-5992
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA427490YY2YMedicare PIN