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General NPI Number Information
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NPI Number | 1912459728
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Entity Type | Individual
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Provider Name | LINDA DESRUISSEAU-REVIS APRN, CNP
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Gender | Female
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 3333 CATTLEMEN RD STE 202
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City | SARASOTA
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State | FL
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Zip | 34232-6058
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Country | US
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Telephone | 941-342-8892
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Fax | 941-342-8893
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Provider Business Mailing Address
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Address Line | 3333 CATTLEMEN RD STE 202
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City | SARASOTA
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State | FL
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Zip | 34232-6058
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Country | US
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Telephone | 941-342-8892
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Fax | 941-342-8893
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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 | ARNP9490973
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9490973
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License Number State | FL
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