Provider Demographics
NPI:1053444521
Name:SUSAN K SAULSBERY ARNP LLC
Entity Type:Organization
Organization Name:SUSAN K SAULSBERY ARNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:SAULSBERY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:404-313-3033
Mailing Address - Street 1:5712 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:BOKEELIA
Mailing Address - State:FL
Mailing Address - Zip Code:33922-3411
Mailing Address - Country:US
Mailing Address - Phone:404-313-3033
Mailing Address - Fax:
Practice Address - Street 1:5712 LINDEN LN
Practice Address - Street 2:
Practice Address - City:BOKEELIA
Practice Address - State:FL
Practice Address - Zip Code:33922-3411
Practice Address - Country:US
Practice Address - Phone:404-313-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9237022363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S20025Medicare UPIN