Provider Demographics
NPI:1366900235
Name:SCAGGS, SARAH (CRNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SCAGGS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5632 MILLS FIELD LN
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:MD
Mailing Address - Zip Code:20676-2055
Mailing Address - Country:US
Mailing Address - Phone:443-975-6112
Mailing Address - Fax:
Practice Address - Street 1:173 SAINT PATRICKS DR STE 201
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5531
Practice Address - Country:US
Practice Address - Phone:301-396-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191143363LF0000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily