1558611772 NPI number — MRS. SARAH ANN GONZALEZ ACNP-BC, APRN

Table of content: MRS. SARAH ANN GONZALEZ ACNP-BC, APRN (NPI 1558611772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558611772 NPI number — MRS. SARAH ANN GONZALEZ ACNP-BC, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
SARAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ACNP-BC, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATTAS
Provider Other First Name:
SARAH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558611772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 DULLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70506-3718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-991-9276
Provider Business Mailing Address Fax Number:
337-943-0846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 BERKSHIRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-4731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-874-2515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  5147 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 005147 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 5016870 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)