MEDICARE: SARAH A. DERRICK F.N.P.

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	363L00000X	Nurse Practitioner	1958	SC
2	363LF0000X	Family Nurse Practitioner	1958	SC
3	363LF0000X	Family Nurse Practitioner	ARNP9388607	FL
4	363LF0000X	Family Nurse Practitioner	5007132	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00810359	OTHER	SC	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578504924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH A. DERRICK F.N.P.

Provider Business Mailing Address
First Line	:	31 CAROLINA OAKS DR
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-8505
Country	:	US
Telephone Number	:	864-980-3202
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 CAROLINA OAKS DR
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-8505
Country	:	US
Telephone Number	:	864-980-3202
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	09/16/2014

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