Basic Information
| Provider Information | |||||||||
| NPI: | 1457329195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POBLETE | ||||||||
| FirstName: | SARAH-JESSICA | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W. KENNEDY BVLD. | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336092501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138441385 | ||||||||
| FaxNumber: | 8132540230 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W. KENNEDY BLVD. | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336092501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138441385 | ||||||||
| FaxNumber: | 8132540230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME69636 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 41315 | 01 | FL | BCBS | OTHER | 379293500 | 05 | FL | MEDICAID |