Provider Demographics
NPI:1477354595
Name:MEDIRATTA, SOPHIA ANNE (AGPCNP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ANNE
Last Name:MEDIRATTA
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:HOESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:96 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7163
Mailing Address - Country:US
Mailing Address - Phone:207-885-9905
Mailing Address - Fax:207-396-5600
Practice Address - Street 1:96 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7163
Practice Address - Country:US
Practice Address - Phone:207-885-9905
Practice Address - Fax:207-396-5600
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP241651363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology