Healthcare Provider Details

I. General information

NPI: 1831600501
Provider Name (Legal Business Name): MICAHLENE YVETTE SARGEANT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6878
  • Fax: 321-843-2172
Mailing address:
  • Phone: 407-649-6878
  • Fax: 321-843-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9110755
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: