Healthcare Provider Details

I. General information

NPI: 1619698230
Provider Name (Legal Business Name): MARCOS JEFFERSON GOMES SARMENTO SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 CLARKS SUMMIT CT
ORLANDO FL
32828-6602
US

IV. Provider business mailing address

1431 CLARKS SUMMIT CT
ORLANDO FL
32828-6602
US

V. Phone/Fax

Practice location:
  • Phone: 321-504-1000
  • Fax:
Mailing address:
  • Phone: 321-504-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTPPA1224
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2747
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number21-221
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: