Healthcare Provider Details

I. General information

NPI: 1053781955
Provider Name (Legal Business Name): SARA SERBUS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19875 N 51ST AVE
GLENDALE AZ
85308-5114
US

IV. Provider business mailing address

4550 E BELL RD STE 170
PHOENIX AZ
85032-9385
US

V. Phone/Fax

Practice location:
  • Phone: 623-581-8998
  • Fax: 623-581-6461
Mailing address:
  • Phone: 480-443-8400
  • Fax: 480-443-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8124
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: