MEDICARE: EMILY CLAIRE SACK ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	9318736	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104284926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY CLAIRE SACK ARNP

Provider Business Mailing Address
First Line	:	2090 COLUMBIANA RD STE 4000
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-2158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 ORIENT RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-3325
Country	:	US
Telephone Number	:	813-247-0805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2016
Last Update Date	:	02/08/2016

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