Provider Demographics
NPI:1790556827
Name:SARPONG, JACINTA BOAFOWAA
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:BOAFOWAA
Last Name:SARPONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2543
Mailing Address - Country:US
Mailing Address - Phone:412-624-4860
Mailing Address - Fax:
Practice Address - Street 1:3500 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2543
Practice Address - Country:US
Practice Address - Phone:412-624-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN782443163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse