MEDICARE: DR. SARA CACERES REYNOLDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	049485	GA
2	207Q00000X	Family Medicine Physician	ME124421	FL

General Provider Information

NPI Number	:	1619967122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA CACERES REYNOLDS MD

Provider Business Mailing Address
First Line	:	PO BOX 1289
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33601-1289
Country	:	US
Telephone Number	:	813-844-4300
Fax Number	:	813-844-1909

Provider Business Practice Location Address
First Line	:	9501 ANDERSON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1252
Country	:	US
Telephone Number	:	813-413-7333
Fax Number	:	813-563-4530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	03/17/2025

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