Provider Demographics
NPI:1962163717
Name:BERTOLI, SARAH ELIZABETH (MSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:BERTOLI
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:BERTOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:300 W DIXIE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1704
Mailing Address - Country:US
Mailing Address - Phone:270-307-1980
Mailing Address - Fax:270-505-4204
Practice Address - Street 1:300 W DIXIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1704
Practice Address - Country:US
Practice Address - Phone:270-307-1980
Practice Address - Fax:270-505-4204
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017200363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner