Provider Demographics
NPI:1114919149
Name:TRAVNICEK, PETRA (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:TRAVNICEK
Suffix:
Gender:F
Credentials:MD
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 25818
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2818
Mailing Address - Country:US
Mailing Address - Phone:941-365-7771
Mailing Address - Fax:941-365-4071
Practice Address - Street 1:1250 SOUTH TAMIAMI TRAIL
Practice Address - Street 2:SUITE 301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2207
Practice Address - Country:US
Practice Address - Phone:941-365-7771
Practice Address - Fax:941-365-4071
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268320200Medicaid
FLP00072804OtherMEDICARE RR
FL81849OtherBCBS
FL600001577OtherTAX ID
FL600001577OtherTAX ID
FL81849ZMedicare ID - Type Unspecified