Provider Demographics
NPI:1730441825
Name:EDMUND, SARA JOYCE (DNP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JOYCE
Last Name:EDMUND
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3614 E SOUTHERN AVE
Mailing Address - Street 2:SUITE A105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2509
Mailing Address - Country:US
Mailing Address - Phone:480-654-2266
Mailing Address - Fax:480-999-5636
Practice Address - Street 1:1424 S 7TH AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007
Practice Address - Country:US
Practice Address - Phone:602-258-3600
Practice Address - Fax:480-999-5636
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP4506363LF0000X
AZAP4506363LP2300X
AZAP9846363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158158Medicaid