Provider Demographics
NPI:1720521917
Name:THACKER, SARA BRATCHER (APRN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BRATCHER
Last Name:THACKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:BRATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:14866 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4801
Practice Address - Country:US
Practice Address - Phone:843-235-0760
Practice Address - Fax:843-235-3026
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20600363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4343Medicaid