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General NPI Number Information
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NPI Number | 1912705278
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Entity Type | Individual
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Provider Name | SARA BUQUICCHIO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 8950 DR M.L.K. JR ST N UNIT 102
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702
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Country | US
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Telephone | 727-498-8898
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 GANDY BLVD N UNIT 811
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702-2125
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Country | US
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Telephone | 386-334-0655
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Fax |
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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 |
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License Number State |
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