Healthcare Provider Details

I. General information

NPI: 1528494580
Provider Name (Legal Business Name): PSG OF SARASOTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 AVION PARK DR STE 120
TAMPA FL
33607-1461
US

IV. Provider business mailing address

5315 AVION PARK DR STE 120
TAMPA FL
33607-1461
US

V. Phone/Fax

Practice location:
  • Phone: 844-650-5802
  • Fax: 844-277-0049
Mailing address:
  • Phone: 844-650-5802
  • Fax: 844-277-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA LYNN STARR
Title or Position: COO
Credential: RN,IGCN
Phone: 844-650-5802