Basic Information
| Provider Information | |||||||||
| NPI: | 1689921116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RECUPERO | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PA-C, RRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 SE MAGNOLIA EXTENSION | ||||||||
| Address2: | UNIT 1 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344713770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524011218 | ||||||||
| FaxNumber: | 3524011017 | ||||||||
| Practice Location | |||||||||
| Address1: | 1234 SE MAGNOLIA EXTENSION | ||||||||
| Address2: | UNIT 1 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344713770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524011218 | ||||||||
| FaxNumber: | 3524011017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 04/19/2013 | ||||||||
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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 | 363AM0700X | PA9106624 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | PA9106624 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 007819400 | 05 | FL | MEDICAID |