Healthcare Provider Details

I. General information

NPI: 1063687838
Provider Name (Legal Business Name): ALEXANDRA BIANCA SARAC D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 HERITAGE BLVD
IMMOKALEE FL
34142
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3000
  • Fax: 237-658-3175
Mailing address:
  • Phone: 239-658-3000
  • Fax: 239-658-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number246035
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS11607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: