Provider Demographics
NPI:1518648518
Name:GOODWIN, SARAH PHILLIPS (CRNA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:PHILLIPS
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3537 TIDAL MARSH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2230
Mailing Address - Country:US
Mailing Address - Phone:912-484-7181
Mailing Address - Fax:
Practice Address - Street 1:13045 CHETS CREEK DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7430
Practice Address - Country:US
Practice Address - Phone:912-484-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9548390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered