Individual
MISS SARA GREENE DIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4712 N ARMENIA AVE STE 102, TAMPA, FL 33603-2611
(813) 879-5716
(813) 877-2611
Mailing address
2995 DREW ST, CLEARWATER, FL 33759-3012
(727) 281-9065
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
47488
KY
208000000X
Pediatrics Physician
Primary
ME169340
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000897766
ANTHEM
KY
01
—
50077879
PASSPORT HEALTH PLAN
KY
05
—
7100315080
—
KY
01
—
K360020
KY MEDICARE
KY
Enumeration date
03/31/2011
Last updated
07/30/2025
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