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General NPI Number Information
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NPI Number | 1790119923
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Entity Type | Individual
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Provider Name | SARA KAY PROCTOR PA
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Gender | Female
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 3228 SAN JOSE MISSION DR
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City | DOVER
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State | FL
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Zip | 33527-4746
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Country | US
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Telephone | 813-707-7376
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Fax | 813-707-7417
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Provider Business Mailing Address
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Address Line | 2510 W SHELL POINT RD LOT 151
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City | RUSKIN
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State | FL
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Zip | 33570-3110
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Country | US
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Telephone | 813-944-8144
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Fax | 813-707-7417
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2530
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License Number State | FL
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