1093866725 NPI number — MRS. SARA A ZEMBALA ARNP

Table of content: MRS. SARA A ZEMBALA ARNP (NPI 1093866725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093866725 NPI number — MRS. SARA A ZEMBALA ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEMBALA
Provider First Name:
SARA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZEMBALA
Provider Other First Name:
SARA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093866725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11214 FIDDLEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33579-7008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-374-7041
Provider Business Mailing Address Fax Number:
813-374-7041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11115 E DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
C/O TAKE CARE HEALTH SYSTEM
Provider Business Practice Location Address City Name:
SEFFNER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33584-8378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-413-3081
Provider Business Practice Location Address Fax Number:
813-413-3082
Provider Enumeration Date:
01/16/2007

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: 363LF0000X , with the licence number:  1241072 , 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)