Healthcare Provider Details

I. General information

NPI: 1114298650
Provider Name (Legal Business Name): SARAH M TOLLESON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 1100
LITTLE ROCK AR
72205-6321
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR STE 1100
LITTLE ROCK AR
72205-6321
US

V. Phone/Fax

Practice location:
  • Phone: 501-748-3214
  • Fax: 501-227-9151
Mailing address:
  • Phone: 501-748-3214
  • Fax: 501-227-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR71666
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA 03613
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: