Healthcare Provider Details

I. General information

NPI: 1104242783
Provider Name (Legal Business Name): SLP HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 SE CONFERENCE CIR
STUART FL
34997-7639
US

IV. Provider business mailing address

1371 SE CONFERENCE CIR
STUART FL
34997-7639
US

V. Phone/Fax

Practice location:
  • Phone: 561-332-2020
  • Fax: 561-300-8613
Mailing address:
  • Phone: 561-332-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN.279615-COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9379549
License Number StateFL

VIII. Authorized Official

Name: SARA LYNN PRATT
Title or Position: APRN/OWNER
Credential: APRN
Phone: 561-332-2020