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General NPI Number Information
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NPI Number | 1114919149
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Entity Type | Individual
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Provider Name | PETRA TRAVNICEK M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 08/30/2015
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Provider Practice Location Address
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Address Line | 1250 SOUTH TAMIAMI TRAIL SUITE 301
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City | SARASOTA
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State | FL
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Zip | 34239-2207
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Country | US
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Telephone | 941-365-7771
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Fax | 941-365-4071
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Provider Business Mailing Address
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Address Line | PO BOX 25818
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City | SARASOTA
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State | FL
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Zip | 34277-2818
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Country | US
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Telephone | 941-365-7771
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Fax | 941-365-4071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME88849
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License Number State | FL
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