Provider Demographics
NPI:1053859421
Name:ROARK, SARAH KATE (RN,MSNL, ACAGNP-BC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATE
Last Name:ROARK
Suffix:
Gender:F
Credentials:RN,MSNL, ACAGNP-BC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATE
Other - Last Name:BREWSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7702
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0702
Mailing Address - Country:US
Mailing Address - Phone:970-663-2742
Mailing Address - Fax:970-342-2093
Practice Address - Street 1:115 E RIVERWALK UNIT 200
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3320
Practice Address - Country:US
Practice Address - Phone:719-543-8346
Practice Address - Fax:719-545-1829
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992793-NP363LA2100X
CO0992793363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0992793OtherSTATE NP LICENSE