Healthcare Provider Details

I. General information

NPI: 1043899354
Provider Name (Legal Business Name): SARA LYNN GAMBONE CPNP-PC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 WINN WAY
DECATUR GA
30030-2106
US

IV. Provider business mailing address

350 WINN WAY
DECATUR GA
30030-2106
US

V. Phone/Fax

Practice location:
  • Phone: 813-451-4372
  • Fax:
Mailing address:
  • Phone: 813-451-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP261798
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN261798
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: