Provider Demographics
NPI:1174912216
Name:MAGOUN, SARA DANETTE (MSN, APN, FNP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DANETTE
Last Name:MAGOUN
Suffix:
Gender:F
Credentials:MSN, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4345
Mailing Address - Country:US
Mailing Address - Phone:615-525-3879
Mailing Address - Fax:
Practice Address - Street 1:355 NEW SHACKLE ISLAND RD
Practice Address - Street 2:TRISTAR HENDERSONVILLE/PORTLAND EMERGENCY DEPARTMENT
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2479
Practice Address - Country:US
Practice Address - Phone:615-338-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily