Provider Demographics
NPI:1902542764
Name:SOUTH, SARA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:SOUTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 MONTALVO
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-9044
Mailing Address - Country:US
Mailing Address - Phone:850-723-2658
Mailing Address - Fax:
Practice Address - Street 1:1221 ANTILLES LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4506
Practice Address - Country:US
Practice Address - Phone:352-678-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018538363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics