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General NPI Number Information
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NPI Number | 1508131178
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Entity Type | Individual
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Provider Name | AMY R STROUP LPN, LMT, FACIALIST
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Gender | Female
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 5460 N STATE ROAD 7 STE 217
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City | FORT LAUDERDALE
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State | FL
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Zip | 33319-2969
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Country | US
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Telephone | 954-895-2697
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Fax |
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Provider Business Mailing Address
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Address Line | 9124 NW 35TH PL
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City | SUNRISE
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State | FL
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Zip | 33351-6400
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Country | US
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Telephone | 954-895-2697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN0547061
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | MA29603
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License Number State | FL
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