Provider Demographics
NPI:1730910860
Name:KECKSTEIN, SAGE ANNE (PA)
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:ANNE
Last Name:KECKSTEIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2277
Mailing Address - Country:US
Mailing Address - Phone:941-524-1127
Mailing Address - Fax:
Practice Address - Street 1:5741 BEE RIDGE RD STE 450
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5081
Practice Address - Country:US
Practice Address - Phone:941-951-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant