Healthcare Provider Details

I. General information

NPI: 1043601842
Provider Name (Legal Business Name): SAUNDRA HOLSETH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 S FLORIDA AVE
LAKELAND FL
33813-2523
US

IV. Provider business mailing address

475 E CENTRAL AVE
WINTER HAVEN FL
33880-3051
US

V. Phone/Fax

Practice location:
  • Phone: 863-401-4401
  • Fax: 866-824-2717
Mailing address:
  • Phone: 863-401-4401
  • Fax: 866-824-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS14412
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14412
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number85870
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: