Provider Demographics
NPI:1174849905
Name:PONCE, SARA R (FNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:PONCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3089
Mailing Address - Country:US
Mailing Address - Phone:808-961-4082
Mailing Address - Fax:
Practice Address - Street 1:15-2866 PAHOA VILLAGE RD BLDG C
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-333-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN204140163W00000X
NY601870163W00000X
HI85267163W00000X
AZAP9868363LF0000X
NY336170363LF0000X
CARN95115360163W00000X
HIRN-85267163W00000X
CANP95005787363LF0000X
HIAPRN2224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY336170OtherNEW YORK STATE LICENSE NUMBER
NY601870OtherNEW YORK STATE REGISTERED PROFESSIONAL NURSING LICENSE NUMBER