Provider Demographics
NPI:1053671214
Name:CETTA, SARA DIANE (APRN-C)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:DIANE
Last Name:CETTA
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 MCMULLEN BOOTH RD FL 1
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6607
Mailing Address - Country:US
Mailing Address - Phone:727-725-6905
Mailing Address - Fax:727-266-4931
Practice Address - Street 1:3231 MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6607
Practice Address - Country:US
Practice Address - Phone:727-725-6905
Practice Address - Fax:727-266-4931
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9259056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106340100Medicaid