Provider Demographics
NPI:1881150860
Name:DEROCHA, SARAH ASHLEY (APN)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ASHLEY
Last Name:DEROCHA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ASHLEY
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:505 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2019
Mailing Address - Country:US
Mailing Address - Phone:864-232-2734
Mailing Address - Fax:864-232-8126
Practice Address - Street 1:505 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2019
Practice Address - Country:US
Practice Address - Phone:864-232-2734
Practice Address - Fax:864-232-8126
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner