Healthcare Provider Details

I. General information

NPI: 1679734172
Provider Name (Legal Business Name): SARA DIANNE MOHR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DRIVE SUITE 1800
JACKSONVILLE FL
32207
US

IV. Provider business mailing address

836 PRUDENTIAL DRIVE SUITE 1800
JACKSONVILLE FL
32207
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-7684
  • Fax:
Mailing address:
  • Phone: 904-398-7684
  • Fax: 904-398-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9172603
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License NumberARNP9172603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: