Healthcare Provider Details

I. General information

NPI: 1881224970
Provider Name (Legal Business Name): SARA JESSICA OHL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 07/15/2024
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 CAMERON VALLEY PKWY STE 4100
CHARLOTTE NC
28211-4369
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-468-8873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5012678
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012678
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: