Healthcare Provider Details

I. General information

NPI: 1841171055
Provider Name (Legal Business Name): LIA SAGARESE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 SE OSCEOLA ST
STUART FL
34994-2577
US

IV. Provider business mailing address

7903 PLANTATION LAKES DR
PORT SAINT LUCIE FL
34986-3005
US

V. Phone/Fax

Practice location:
  • Phone: 772-276-7242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: