Provider Demographics
NPI:1689921116
Name:RECUPERO, SARAH LYNN (PA-C, RRT)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:LYNN
Last Name:RECUPERO
Suffix:
Gender:F
Credentials:PA-C, RRT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1234 SE MAGNOLIA EXTENSION
Mailing Address - Street 2:UNIT 1
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3770
Mailing Address - Country:US
Mailing Address - Phone:352-401-1218
Mailing Address - Fax:352-401-1017
Practice Address - Street 1:1234 SE MAGNOLIA EXTENSION
Practice Address - Street 2:UNIT 1
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3770
Practice Address - Country:US
Practice Address - Phone:352-401-1218
Practice Address - Fax:352-401-1017
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA9106624363AM0700X
FLPA9106624363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007819400Medicaid
FLGS310ZMedicare PIN