Provider Demographics
NPI:1346086162
Name:WISE, SARA LINDSAY (FNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LINDSAY
Last Name:WISE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6942 SHIMMERING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3331
Mailing Address - Country:US
Mailing Address - Phone:863-287-2880
Mailing Address - Fax:
Practice Address - Street 1:6942 SHIMMERING DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3331
Practice Address - Country:US
Practice Address - Phone:863-287-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily