Healthcare Provider Details

I. General information

NPI: 1396077210
Provider Name (Legal Business Name): SARAH OLIVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH BRATT PA-C

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S CONGRESS AVE
LAKE WORTH FL
33461-4746
US

IV. Provider business mailing address

5000 W OAKLAND PARK BLVD FLORIDA MEDICAL CENTER
FORT LAUDERDALE FL
33313
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax: 561-433-4175
Mailing address:
  • Phone: 561-967-6500
  • Fax: 561-433-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000000898
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number09-1124
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: