Provider Demographics
NPI:1376527283
Name:SAPIENZA, JOHN W (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SAPIENZA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FLORIDA PARK DR N
Mailing Address - Street 2:STE 101A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3852
Mailing Address - Country:US
Mailing Address - Phone:386-446-3434
Mailing Address - Fax:
Practice Address - Street 1:1 FLORIDA PARK DR N
Practice Address - Street 2:STE 101A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3852
Practice Address - Country:US
Practice Address - Phone:386-446-3434
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2796213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46635Medicare ID - Type Unspecified
FLT51223Medicare UPIN