Provider Demographics
NPI:1003222191
Name:SAUCEDO, ISRAEL (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:OMEGA
Mailing Address - State:GA
Mailing Address - Zip Code:31775-3075
Mailing Address - Country:US
Mailing Address - Phone:229-242-9310
Mailing Address - Fax:
Practice Address - Street 1:417 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1943
Practice Address - Country:US
Practice Address - Phone:229-312-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170526363LA2100X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care