MEDICARE: MRS. SARA GRACE BERTRAND 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	363L00000X	Nurse Practitioner	9314228	FL

General Provider Information

NPI Number	:	1629599030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA GRACE BERTRAND ARNP

Provider Business Mailing Address
First Line	:	155 CRANES ROOST BLVD STE 2060
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3489
Country	:	US
Telephone Number	:	407-949-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 CRANES ROOST BLVD STE 2060
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3489
Country	:	US
Telephone Number	:	407-949-0222
Fax Number	:

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

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	09/05/2020

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