=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053457655
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONJA M. O'FLYNN ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2223 N WASHINGTON BLVD GENESIS HEALTH SERVICES, INC
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-957-1970
-----------------------------------------------------
Fax | 941-957-1960
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4250 PLAYERS PL UNIT 2617
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34238-5450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-926-9174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP2545292
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------