Healthcare Provider Details

I. General information

NPI: 1467210252
Provider Name (Legal Business Name): SARAH FLORES REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

122 ELM ST
STATEN ISLAND NY
10310-1545
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 917-524-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number787926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: