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General NPI Number Information
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NPI Number | 1619738762
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Entity Type | Individual
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Provider Name | SASSY SOUDERS APRN
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Gender | Female
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 463 TEAL LN
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4746
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Country | US
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Telephone | 850-524-3138
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Fax |
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Provider Business Mailing Address
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Address Line | 463 TEAL LN
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4746
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Country | US
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Telephone | 850-524-3138
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11030519
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License Number State | FL
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