Provider Demographics
NPI:1770355596
Name:HAUGEN, SARA ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 RIO DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2442
Mailing Address - Country:US
Mailing Address - Phone:904-654-8393
Mailing Address - Fax:
Practice Address - Street 1:97 RIO DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2442
Practice Address - Country:US
Practice Address - Phone:904-654-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2023022013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily