Healthcare Provider Details

I. General information

NPI: 1760519912
Provider Name (Legal Business Name): SARAH GEMMA PUCCINELLI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAM GIROLAMO PUCCINELLI

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 BEE RIDGE RD STE 200
SARASOTA FL
34233
US

IV. Provider business mailing address

PO BOX 25487
SARASOTA FL
34277-2487
US

V. Phone/Fax

Practice location:
  • Phone: 941-927-5178
  • Fax: 941-921-6838
Mailing address:
  • Phone: 941-202-5342
  • Fax: 855-253-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002542
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: