Provider Demographics
NPI:1194711333
Name:SARSAM, DENISE C (RN,MSN,FNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:C
Last Name:SARSAM
Suffix:
Gender:F
Credentials:RN,MSN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 N CAMINO MERCADO
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5759
Mailing Address - Country:US
Mailing Address - Phone:520-836-5538
Mailing Address - Fax:520-836-6998
Practice Address - Street 1:560 N CAMINO MERCADO
Practice Address - Street 2:SUITE 7
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5759
Practice Address - Country:US
Practice Address - Phone:520-836-5538
Practice Address - Fax:520-836-6998
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ639594Medicaid
AZ639594Medicaid