Basic Information
| Provider Information | |||||||||
| NPI: | 1174836407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWALD | ||||||||
| FirstName: | SARINA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 917770 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328917770 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 TAMPA GENERAL CIR | ||||||||
| Address2: | STC 5TH FLOOR | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132598700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2010 | ||||||||
| LastUpdateDate: | 11/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP1700X | ARNP3332252 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Perinatal |
ID Information
| ID | Type | State | Issuer | Description | 002382100 | 05 | FL | MEDICAID | Y05AY | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |