Provider Demographics
NPI:1548449655
Name:SANABRIA, SARAH J (RN, NP, MS)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:J
Last Name:SANABRIA
Suffix:
Gender:F
Credentials:RN, NP, MS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:TAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3883 AIRWAY DR
Mailing Address - Street 2:#202
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1670
Mailing Address - Country:US
Mailing Address - Phone:707-521-8900
Mailing Address - Fax:707-523-1308
Practice Address - Street 1:3883 AIRWAY DR
Practice Address - Street 2:#202
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1670
Practice Address - Country:US
Practice Address - Phone:707-521-8900
Practice Address - Fax:707-523-1308
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA641381163W00000X
CA17623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00477446OtherMEDICARE PTAN