Provider Demographics
NPI:1356969729
Name:KOVACIC, SARAH ANTOINETTE (APRN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANTOINETTE
Last Name:KOVACIC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25350 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-7110
Mailing Address - Country:US
Mailing Address - Phone:440-358-3590
Mailing Address - Fax:440-358-3590
Practice Address - Street 1:1511 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1000
Practice Address - Country:US
Practice Address - Phone:800-230-7526
Practice Address - Fax:440-358-3590
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994726-NP363LF0000X
OHAPRN.CNP.0029603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0459905Medicaid