Healthcare Provider Details

I. General information

NPI: 1699458968
Provider Name (Legal Business Name): SARA MATTHEWS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 TUSCANNY ST
BRANDON FL
33511-6163
US

IV. Provider business mailing address

529 TUSCANNY ST
BRANDON FL
33511-6163
US

V. Phone/Fax

Practice location:
  • Phone: 305-332-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: