Provider Demographics
NPI:1417570912
Name:GREENE, SARA KRISTEN (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:KRISTEN
Last Name:GREENE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:KRISTEN
Other - Last Name:SWENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3411 NW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2215
Mailing Address - Country:US
Mailing Address - Phone:352-514-9565
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006210363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care