Healthcare Provider Details

I. General information

NPI: 1710649322
Provider Name (Legal Business Name): SARA PHUONG THIHA HOANG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W CORAL WAY
HOLLYWOOD FL
33021-3860
US

IV. Provider business mailing address

513 RACQUET CLUB RD APT 56
WESTON FL
33326-1873
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-2009
  • Fax:
Mailing address:
  • Phone: 317-760-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11013928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: