=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689412819
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTINA VUCINA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2024
-----------------------------------------------------
Last Update Date | 07/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5804 BEE RIDGE RD
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-5051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-378-5020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7054 TAMWORTH PKWY
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34241-2707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-599-4609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS67285
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------