Provider Demographics
NPI:1669111415
Name:SCRUBY, SARAH CATHERINE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CATHERINE
Last Name:SCRUBY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 EGREMONT DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5343
Mailing Address - Country:US
Mailing Address - Phone:904-305-1426
Mailing Address - Fax:
Practice Address - Street 1:2321 EGREMONT DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5343
Practice Address - Country:US
Practice Address - Phone:904-305-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9116189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant