Provider Demographics
NPI:1366064545
Name:BASTIDA, SARAH KIMBERLY (FNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KIMBERLY
Last Name:BASTIDA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5217
Mailing Address - Country:US
Mailing Address - Phone:541-870-9413
Mailing Address - Fax:
Practice Address - Street 1:995 WILLAGILLESPIE RD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2153
Practice Address - Country:US
Practice Address - Phone:541-228-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10008329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine