Provider Demographics
NPI:1700471224
Name:COOPER, SARA MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:MARIE
Last Name:COOPER
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 1:17440 N TATUM BLVD APT 284
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9356
Mailing Address - Country:US
Mailing Address - Phone:480-751-9024
Mailing Address - Fax:
Practice Address - Street 1:7010 E CHAUNCEY LN STE 225
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3117
Practice Address - Country:US
Practice Address - Phone:480-585-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ8700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant