Provider Demographics
NPI:1861082869
Name:WELLER, SARAH DIANA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:DIANA
Last Name:WELLER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 S US 301 STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5806
Mailing Address - Country:US
Mailing Address - Phone:937-408-6064
Mailing Address - Fax:
Practice Address - Street 1:10420 S US 301 STE 2
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5806
Practice Address - Country:US
Practice Address - Phone:813-551-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily