Provider Demographics
NPI:1891140638
Name:SARPONG, FREDERICK (FNP)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:SARPONG
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 E LATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4445
Mailing Address - Country:US
Mailing Address - Phone:909-794-0200
Mailing Address - Fax:
Practice Address - Street 1:1215 N WABASH AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4963
Practice Address - Country:US
Practice Address - Phone:909-794-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95004084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner