Healthcare Provider Details

I. General information

NPI: 1134789571
Provider Name (Legal Business Name): SARA BEASLEY RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

V. Phone/Fax

Practice location:
  • Phone: 352-258-2163
  • Fax:
Mailing address:
  • Phone: 352-265-0400
  • Fax: 352-265-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND8467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: