Healthcare Provider Details

I. General information

NPI: 1356969729
Provider Name (Legal Business Name): SARAH ANTOINETTE KOVACIC APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E STATE ST STE 233
COLUMBUS OH
43215-4281
US

IV. Provider business mailing address

21 E STATE ST STE 233
COLUMBUS OH
43215-4281
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029603
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994726-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: