Provider Demographics
NPI:1457329195
Name:POBLETE, SARAH-JESSICA P (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH-JESSICA
Middle Name:P
Last Name:POBLETE
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 1:2501 W. KENNEDY BVLD.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2501
Mailing Address - Country:US
Mailing Address - Phone:813-844-1385
Mailing Address - Fax:813-254-0230
Practice Address - Street 1:2501 W. KENNEDY BLVD.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2501
Practice Address - Country:US
Practice Address - Phone:813-844-1385
Practice Address - Fax:813-254-0230
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41315OtherBCBS
FL379293500Medicaid
G52663Medicare UPIN
FL41315WMedicare ID - Type Unspecified