Healthcare Provider Details

I. General information

NPI: 1053444521
Provider Name (Legal Business Name): SUSAN K SAULSBERY ARNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5712 LINDEN LN
BOKEELIA FL
33922-3411
US

IV. Provider business mailing address

5712 LINDEN LN
BOKEELIA FL
33922-3411
US

V. Phone/Fax

Practice location:
  • Phone: 404-313-3033
  • Fax:
Mailing address:
  • Phone: 404-313-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9237022
License Number StateFL

VIII. Authorized Official

Name: SUSAN KATHRYN SAULSBERY
Title or Position: MANAGING MEMBER
Credential: ARNP
Phone: 404-313-3033