=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912836982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G SARLIS GROUP INC DBA SELF360
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2026
-----------------------------------------------------
Last Update Date | 05/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 NW 70TH AVE STE 10
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33317-2911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-302-4373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 NW 70TH AVE STE 10
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33317-2911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-302-4373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GLENDA SARLI
-----------------------------------------------------
Credential | DNP, FNP-BC
-----------------------------------------------------
Telephone | 786-252-3353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------