Provider Demographics
NPI:1972822559
Name:TURSE, SARA SERGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:SERGE
Last Name:TURSE
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 1:200 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3100
Mailing Address - Country:US
Mailing Address - Phone:321-733-1111
Mailing Address - Fax:321-733-1114
Practice Address - Street 1:200 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3100
Practice Address - Country:US
Practice Address - Phone:321-733-1111
Practice Address - Fax:321-733-1114
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-22
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
07569OtherMEDICARE ID - TYPE UNSPECIFIED