Healthcare Provider Details

I. General information

NPI: 1871116152
Provider Name (Legal Business Name): ZARA SABA AZHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 SW INNOVATION WAY
PORT ST LUCIE FL
34987-2117
US

IV. Provider business mailing address

10050 SW INNOVATION WAY STE 102
PORT ST LUCIE FL
34987-2117
US

V. Phone/Fax

Practice location:
  • Phone: 772-344-3811
  • Fax:
Mailing address:
  • Phone: 772-344-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number159718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: