MEDICARE: MS. SARAH V ETTI

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	1041C0700X	Clinical Social Worker	SW19171	FL

General Provider Information

NPI Number	:	1255031431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH V ETTI

Provider Business Mailing Address
First Line	:	3702 W SPRUCE ST # 1287
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2553
Country	:	US
Telephone Number	:	813-419-0073
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 TECH BLVD
Second Line	:	STE 145
City	:	TAMPA
State	:	FL
Zip	:	33619-2553
Country	:	US
Telephone Number	:	813-419-0073
Fax Number	:

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

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/07/2023

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Directions to “ MS. SARAH V ETTI ” Practice Location

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