Healthcare Provider Details

I. General information

NPI: 1376113928
Provider Name (Legal Business Name): SARA RUTH BAGGE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA FUGAZZOTTO

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

940 BELMONT ST
BROCKTON MA
02301-5596
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-4500
  • Fax:
Mailing address:
  • Phone: 508-583-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2279290
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2279290
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: