Provider Demographics
NPI:1356117279
Name:VASQUES, SARA (APRN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VASQUES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 HURFFVILLE CROSSKEYS RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4005
Mailing Address - Country:US
Mailing Address - Phone:856-220-3540
Mailing Address - Fax:
Practice Address - Street 1:239 HURFFVILLE CROSSKEYS RD STE 160
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4005
Practice Address - Country:US
Practice Address - Phone:856-341-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14966300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0985040Medicaid