Provider Demographics
NPI:1871117929
Name:THOMPSON, SARA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12353 SILTON PEACE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3935
Mailing Address - Country:US
Mailing Address - Phone:740-601-4439
Mailing Address - Fax:
Practice Address - Street 1:12353 SILTON PEACE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-3935
Practice Address - Country:US
Practice Address - Phone:740-601-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9510243163W00000X
OH431561163W00000X
FL11007282363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse