Provider Demographics
NPI:1619967122
Name:CACERES REYNOLDS, SARA (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:CACERES REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:CACERES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-4300
Mailing Address - Fax:813-844-1909
Practice Address - Street 1:9501 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1252
Practice Address - Country:US
Practice Address - Phone:813-413-7333
Practice Address - Fax:813-563-4530
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049485207Q00000X
FLME124421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH63631Medicare UPIN
FLP01809967-RAILROADMedicare PIN