Healthcare Provider Details

I. General information

NPI: 1730910860
Provider Name (Legal Business Name): SAGE ANNE KECKSTEIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 BEE RIDGE RD STE 450
SARASOTA FL
34233-5081
US

IV. Provider business mailing address

6716 1ST AVE W
BRADENTON FL
34209-2277
US

V. Phone/Fax

Practice location:
  • Phone: 941-951-2663
  • Fax:
Mailing address:
  • Phone: 941-524-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: