Healthcare Provider Details

I. General information

NPI: 1124128103
Provider Name (Legal Business Name): SERGIO J. JACINTO, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4507 N. ARMENIA AVE
TAMPA FL
33603
US

IV. Provider business mailing address

4507 N. ARMENIA AVE
TAMPA FL
33603
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-4100
  • Fax: 813-876-4153
Mailing address:
  • Phone: 813-876-4100
  • Fax: 813-876-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0066271
License Number StateFL

VIII. Authorized Official

Name: MRS. YANET PACHECO
Title or Position: OFFICE MANAGER
Credential:
Phone: 813-876-4100