Provider Demographics
NPI:1033408463
Name:NAGY, SARA KIETZMAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KIETZMAN
Last Name:NAGY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DARLENE
Other - Last Name:KIETZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:14806 MORNING DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3270
Mailing Address - Country:US
Mailing Address - Phone:941-681-0323
Mailing Address - Fax:
Practice Address - Street 1:14806 MORNING DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-3270
Practice Address - Country:US
Practice Address - Phone:941-681-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5353235Z00000X
FLSA11769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist