Provider Demographics
NPI:1417367707
Name:VANCE, SARAH CAROLINE MOODY (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CAROLINE MOODY
Last Name:VANCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N INTERSTATE 35 STE 600
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1850
Mailing Address - Country:US
Mailing Address - Phone:512-633-0485
Mailing Address - Fax:
Practice Address - Street 1:3000 N INTERSTATE 35 STE 600
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1850
Practice Address - Country:US
Practice Address - Phone:512-633-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant