Healthcare Provider Details

I. General information

NPI: 1629079520
Provider Name (Legal Business Name): SARA ANN BOHN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/01/2021
Certification Date: 06/23/2021
Deactivation Date: 03/22/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

105 ARNESON AVE
AUBURNDALE FL
33823-3229
US

IV. Provider business mailing address

423 PALASTRO AVE
AUBURNDALE FL
33823-8704
US

V. Phone/Fax

Practice location:
  • Phone: 863-393-6404
  • Fax: 863-583-3118
Mailing address:
  • Phone: 573-353-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number36976
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36976
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: