Provider Demographics
NPI:1053094532
Name:ASCENCIO, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ASCENCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 USA DRIVE NORTH
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-6007
Mailing Address - Country:US
Mailing Address - Phone:251-445-9334
Mailing Address - Fax:
Practice Address - Street 1:5721 USA DRIVE NORTH
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-6007
Practice Address - Country:US
Practice Address - Phone:251-445-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant