Healthcare Provider Details

I. General information

NPI: 1720497241
Provider Name (Legal Business Name): RENEE ST LAURENT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 6TH AVE W
BRADENTON FL
34205-8820
US

IV. Provider business mailing address

PO BOX 9478
BRADENTON FL
34206-9478
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4100
  • Fax: 941-782-4101
Mailing address:
  • Phone: 941-782-4299
  • Fax: 941-782-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9282114
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: