Provider Demographics
NPI:1750619474
Name:FERRER-BRUKER, SARAH JEAN (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:FERRER-BRUKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:FERRER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:906 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4120
Mailing Address - Country:US
Mailing Address - Phone:904-541-0315
Mailing Address - Fax:904-541-0316
Practice Address - Street 1:316 PASEO REYES DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8464
Practice Address - Country:US
Practice Address - Phone:904-544-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLU02251207R00000X
FLOS11363207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9927OtherGRP MCR NUMBER
FL150LWOtherBCBS
FLIF431ZMedicare PIN