MEDICARE: MS. SARA ANN FITZPATRICK CRNA

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	367500000X	Certified Registered Nurse Anesthetist	046620	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88932U	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1558437236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA ANN FITZPATRICK CRNA

Provider Business Mailing Address
First Line	:	2628 LANDIS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3408
Country	:	US
Telephone Number	:	808-780-4991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2628 LANDIS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3408
Country	:	US
Telephone Number	:	808-780-4991
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	10/16/2008

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