Provider Demographics
NPI:1073696266
Name:SAG, JOANNE LYNN (ARPN)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:LYNN
Last Name:SAG
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741240
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-1240
Mailing Address - Country:US
Mailing Address - Phone:386-774-5211
Mailing Address - Fax:386-774-5251
Practice Address - Street 1:5401 ALHAMBRA AVENUE
Practice Address - Street 2:SUITE D RICHARD M SAG MD PA
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7081
Practice Address - Country:US
Practice Address - Phone:407-297-1497
Practice Address - Fax:407-297-8917
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1894492208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303592100Medicaid