Basic Information
| Provider Information | |||||||||
| NPI: | 1972108199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARBULLIDO | ||||||||
| FirstName: | SARAH LYNN | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5838 HARBOUR VIEW BLVD STE 240 | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234352663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574833030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5838 HARBOUR VIEW BLVD STE 240 | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234352663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574833030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2020 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024182191 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0001303209 | 01 | VA | REGISTERED NURSE | OTHER | 0024182191 | 01 | VA | NURSE PRACTITIONER LICENSE | OTHER |