Provider Demographics
NPI:1922203686
Name:VELASQUEZ, SARAH PEARSON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:PEARSON
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1024 KEITH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069
Mailing Address - Country:US
Mailing Address - Phone:478-987-3445
Mailing Address - Fax:478-987-3102
Practice Address - Street 1:1024 KEITH DRIVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069
Practice Address - Country:US
Practice Address - Phone:478-987-3445
Practice Address - Fax:478-987-3102
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117494363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN117494OtherGA BOARD OF NURSING LIC #