Provider Demographics
NPI:1336542075
Name:MCCARTHY, SARA VERONICA (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:VERONICA
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:VERONICA
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-619-1080
Practice Address - Street 1:1865 LIME STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-321-8400
Practice Address - Fax:904-321-8401
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant