1710389903 NPI number — MS. SARAH ANNETTE RANSOM PHYSICIAN ASSISTANT

Table of content: ASHLEA COLEMAN (NPI 1043946809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710389903 NPI number — MS. SARAH ANNETTE RANSOM PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANSOM
Provider First Name:
SARAH
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OAKES
Provider Other First Name:
SARAH
Provider Other Middle Name:
ANNETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710389903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3005 AMBROSE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37207-4709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-673-6968
Provider Business Mailing Address Fax Number:
844-673-6968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SW ARCHER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-4392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-265-0761
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2014

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: 363A00000X , with the licence number:  PA9107992 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003173157A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014699600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111350000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".