Healthcare Provider Details

I. General information

NPI: 1427543966
Provider Name (Legal Business Name): SARAH F HAMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10875 SE 165TH TERRACE RD
OCKLAWAHA FL
32179-5859
US

IV. Provider business mailing address

676 MIDDLEBURY LOOP
NEW SMYRNA BEACH FL
32168-2118
US

V. Phone/Fax

Practice location:
  • Phone: 352-445-5498
  • Fax:
Mailing address:
  • Phone: 352-445-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL5988
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: