Provider Demographics
NPI:1992895536
Name:HLAVACEK, SARAH A (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:HLAVACEK
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 1:3404 WAKE FOREST RD STE 302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7341
Mailing Address - Country:US
Mailing Address - Phone:919-862-5400
Mailing Address - Fax:919-954-3038
Practice Address - Street 1:3404 WAKE FOREST RD STE 302
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7341
Practice Address - Country:US
Practice Address - Phone:919-862-5400
Practice Address - Fax:919-954-3038
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02040363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762109OtherMEDICARE PTAN