Healthcare Provider Details

I. General information

NPI: 1972193217
Provider Name (Legal Business Name): SARAH LOCKWOOD AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 1/2 MARGUERITE AVE
CORONA DEL MAR CA
92625-4204
US

IV. Provider business mailing address

219 1/2 MARGUERITE AVE
CORONA DEL MAR CA
92625-4204
US

V. Phone/Fax

Practice location:
  • Phone: 949-209-1563
  • Fax: 949-239-1756
Mailing address:
  • Phone: 949-209-1563
  • Fax: 949-539-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95016084
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95016084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: