Provider Demographics
NPI:1811977614
Name:BARONI, SARAH M (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:BARONI
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:PO BOX 30532
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1532
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:850-916-3710
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7809
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:850-916-3710
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052244363A00000X
FLPA9105276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL115403Medicaid
AL592-09663OtherBLUE CROSS BLUE SHIELD
FLY03RCOtherBLUE CROSS BLUE SHIELD
AL115402Medicaid
AL593-06978OtherBLUE CROSS BLUE SHIELD
AL592-09664OtherBLUE CROSS BLUE SHIELD
AL592-09664OtherBLUE CROSS BLUE SHIELD
AL593-06978OtherBLUE CROSS BLUE SHIELD
FLCR065ZMedicare PIN