Provider Demographics
NPI:1992317390
Name:STARK, SARA PATRICE (FNP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:PATRICE
Last Name:STARK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 AQUARIUS CT APT 15
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3800
Mailing Address - Country:US
Mailing Address - Phone:661-444-0094
Mailing Address - Fax:
Practice Address - Street 1:8307 BRIMHALL RD STE 1706
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-4343
Practice Address - Country:US
Practice Address - Phone:661-467-1477
Practice Address - Fax:661-616-9303
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015171363LA2200X, 363L00000X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily