Healthcare Provider Details

I. General information

NPI: 1821638909
Provider Name (Legal Business Name): SARA CHRISTINA BEAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SARA CHRISTINA FLORSCHUTZ

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17945 HUNTING BOW CIR STE 102
LUTZ FL
33558-5376
US

IV. Provider business mailing address

1010 LAKE ST STE 100
OAK PARK IL
60301-1106
US

V. Phone/Fax

Practice location:
  • Phone: 507-254-7047
  • Fax:
Mailing address:
  • Phone: 708-790-5200
  • Fax: 123-456-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11004314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: