Provider Demographics
NPI:1174849905
Name:PONCE, SARA R (FNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:PONCE
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 1:340 4TH AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-866-6848
Mailing Address - Fax:
Practice Address - Street 1:340 4TH AVE STE 14
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-866-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-85267163W00000X, 163W00000X
HI85267163W00000X
NY601870163W00000X
CARN95115360163W00000X
HIAPRN2224363LF0000X, 363LF0000X
CANP95005787363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005787OtherFNP CA STATE
CA95115360OtherRN CALIFORNIA STATE