Provider Demographics
NPI:1205077120
Name:POLATAS, EMILY ANN (LMT)
Entity type:Individual
Prefix:MR
First Name:EMILY
Middle Name:ANN
Last Name:POLATAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 SAWGRASS VILLAGE CIR
Mailing Address - Street 2:SUITE 36
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5016
Mailing Address - Country:US
Mailing Address - Phone:904-940-5445
Mailing Address - Fax:
Practice Address - Street 1:13000 SAWGRASS VILLAGE CIR
Practice Address - Street 2:SUITE 36
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5016
Practice Address - Country:US
Practice Address - Phone:904-940-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist