Healthcare Provider Details

I. General information

NPI: 1669092110
Provider Name (Legal Business Name): SARA MARIE OCAMPO DENSLOW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ARRICOLA AVE
SAINT AUGUSTINE FL
32080-4515
US

IV. Provider business mailing address

100 ARRICOLA AVE
SAINT AUGUSTINE FL
32080-4515
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-4368
  • Fax:
Mailing address:
  • Phone: 904-825-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: