Provider Demographics
NPI:1154704484
Name:RUDNIK, SARA GRACE (CPNP-RNC-NIC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:GRACE
Last Name:RUDNIK
Suffix:
Gender:F
Credentials:CPNP-RNC-NIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 OFFICE PARK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRODENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203
Mailing Address - Country:US
Mailing Address - Phone:941-755-7000
Mailing Address - Fax:
Practice Address - Street 1:5255 OFFICE PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BRODENTON
Practice Address - State:FL
Practice Address - Zip Code:34203
Practice Address - Country:US
Practice Address - Phone:941-755-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY684424163WN0002X, 163WP0200X
FLRN9441496163WN0002X
NY382602363LP0200X
FLARNP9441496363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019008500Medicaid