Provider Demographics
NPI:1972267540
Name:MEBRAHTU, SARA (NP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MEBRAHTU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 XAVIER DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2762
Mailing Address - Country:US
Mailing Address - Phone:615-705-1973
Mailing Address - Fax:
Practice Address - Street 1:463 W SAM RIDLEY PKWY
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5626
Practice Address - Country:US
Practice Address - Phone:615-768-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000030643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily