Healthcare Provider Details

I. General information

NPI: 1346948320
Provider Name (Legal Business Name): SARAH ROSE HUBECK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S KINGS AVE STE 3100
BRANDON FL
33511-5921
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-9171
  • Fax: 877-409-2423
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11024407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: