Provider Demographics
NPI:1891048856
Name:VILLERE, SARAH (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VILLERE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-09 28TH ST FL 20
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4130
Mailing Address - Country:US
Mailing Address - Phone:646-916-0348
Mailing Address - Fax:
Practice Address - Street 1:295 FLATBUSH AVENUE EXT FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3001
Practice Address - Country:US
Practice Address - Phone:469-160-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY700509163W00000X
CO1626500163W00000X
CO0991311363L00000X
NY307307363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner