MEDICARE: MS. SOPHONIE SATINE FNP-BC

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	363LF0000X	Family Nurse Practitioner	11000310	FL

General Provider Information

NPI Number	:	1326502386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SOPHONIE SATINE FNP-BC

Provider Business Mailing Address
First Line	:	4802 LIMERICK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-9106
Country	:	US
Telephone Number	:	813-458-1736
Fax Number	:

Provider Business Practice Location Address
First Line	:	4802 LIMERICK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-9106
Country	:	US
Telephone Number	:	813-458-1736
Fax Number	:

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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