Healthcare Provider Details

I. General information

NPI: 1598379950
Provider Name (Legal Business Name): SARA ROSE BELMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

6102 NW 111TH PL
ALACHUA FL
32615-7421
US

V. Phone/Fax

Practice location:
  • Phone: 850-459-3812
  • Fax:
Mailing address:
  • Phone: 850-459-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11007358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: