Provider Demographics
NPI:1710649322
Name:HOANG, SARA PHUONG THIHA (APRN)
Entity Type:Individual
Prefix:
First Name:SARA PHUONG
Middle Name:THIHA
Last Name:HOANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 RACQUET CLUB RD APT 56
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1873
Mailing Address - Country:US
Mailing Address - Phone:317-760-8366
Mailing Address - Fax:
Practice Address - Street 1:111 W CORAL WAY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3860
Practice Address - Country:US
Practice Address - Phone:954-962-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily