Provider Demographics
NPI:1790119923
Name:PROCTOR, SARA KAY (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KAY
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2510 W SHELL POINT RD LOT 151
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3110
Mailing Address - Country:US
Mailing Address - Phone:813-944-8144
Mailing Address - Fax:813-707-7417
Practice Address - Street 1:3228 SAN JOSE MISSION DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-4746
Practice Address - Country:US
Practice Address - Phone:813-707-7376
Practice Address - Fax:813-707-7417
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2530363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical