=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487738787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALLY ANN FREEMAN A.R.N.P., C.P.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 08/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3191 CLAY MANGUM LN
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33618-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-264-3807
-----------------------------------------------------
Fax | 813-264-8931
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18631 LE DAUPHINE PL
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33558-2886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-789-3642
-----------------------------------------------------
Fax | 813-932-0667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP2814692
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | ARNP2814692
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP2814692
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------