Basic Information
Provider Information
NPI: 1609494426
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMLIN
FirstName: SARAH
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 38135 MARKET SQ
Address2:  
City: ZEPHYRHILLS
State: FL
PostalCode: 335427505
CountryCode: US
TelephoneNumber: 3525670188
FaxNumber:  
Practice Location
Address1: 2020 TOWN CENTER BLVD STE C
Address2:  
City: BRANDON
State: FL
PostalCode: 335112906
CountryCode: US
TelephoneNumber: 8136331980
FaxNumber: 8133555104
Other Information
ProviderEnumerationDate: 07/08/2020
LastUpdateDate: 07/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAPRN11006047FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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