MEDICARE: MISS SARA L TENNANT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	001001027	NC

General Provider Information

NPI Number	:	1114114824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SARA L TENNANT PA-C

Provider Business Mailing Address
First Line	:	7912 SANDERLING PL
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-8729
Country	:	US
Telephone Number	:	910-622-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3015 ENTERPRISE DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2116
Country	:	US
Telephone Number	:	865-500-1232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	02/03/2022

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