1487882171 NPI number — SARA RAGALIE WEEKS CRNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487882171 NPI number — SARA RAGALIE WEEKS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEKS
Provider First Name:
SARA
Provider Middle Name:
RAGALIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAGALIE
Provider Other First Name:
SARA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487882171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 N ASHLEY DR
Provider Second Line Business Mailing Address:
SUITE 1625
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33602-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-844-4434
Provider Business Mailing Address Fax Number:
813-844-4972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 TAMPA GENERAL CIR
Provider Second Line Business Practice Location Address:
SUITE A327
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33606-3571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-844-7677
Provider Business Practice Location Address Fax Number:
813-844-4972
Provider Enumeration Date:
07/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  ARNP9212119 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001497400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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