Provider Demographics
NPI:1912607334
Name:SAY SMITH, SARA BUNLOETH (ARNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BUNLOETH
Last Name:SAY SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7675
Mailing Address - Country:US
Mailing Address - Phone:813-365-3525
Mailing Address - Fax:813-435-3304
Practice Address - Street 1:517 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4504
Practice Address - Country:US
Practice Address - Phone:863-648-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL663776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty