Provider Demographics
NPI:1053877225
Name:PALLER, SARA A (APRN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:PALLER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:ASCHEBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4310 METRO PKWY
Mailing Address - Street 2:STE 205
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9416
Mailing Address - Country:US
Mailing Address - Phone:239-236-8784
Mailing Address - Fax:239-790-2624
Practice Address - Street 1:350 7TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5754
Practice Address - Country:US
Practice Address - Phone:239-624-1660
Practice Address - Fax:239-624-1661
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9404135363LP0808X
FLAPRN11001545363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102349500Medicaid
FLPENDINGOtherBCBS