Provider Demographics
NPI:1154988814
Name:ISRAEL, SARA GENA (APRN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:GENA
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:SHREE
Other - Last Name:PENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3440 HOLLYWOOD BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3440 HOLLYWOOD BLVD STE 415
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6933
Practice Address - Country:US
Practice Address - Phone:954-296-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003803363LP0808X
NYF404060363LP0808X
FLAPRN11002526363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health