Provider Demographics
NPI:1396308672
Name:ARDILA, SARA (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ARDILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 BUDINGER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4123
Mailing Address - Country:US
Mailing Address - Phone:074-983-5404
Mailing Address - Fax:321-843-5863
Practice Address - Street 1:1330 BUDINGER AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4123
Practice Address - Country:US
Practice Address - Phone:074-983-5404
Practice Address - Fax:321-843-5863
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1754162086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL127537700Medicaid