Provider Demographics
NPI:1265674857
Name:ROTHMAN, PHYLLIS SUE (RN,CCM,CDMS,CLCP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:SUE
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:RN,CCM,CDMS,CLCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46678
Mailing Address - Street 2:
Mailing Address - City:PASS A GRILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33741-6678
Mailing Address - Country:US
Mailing Address - Phone:727-367-5450
Mailing Address - Fax:727-367-5630
Practice Address - Street 1:7070PLACIDA ROAD
Practice Address - Street 2:
Practice Address - City:PLACIDA
Practice Address - State:FL
Practice Address - Zip Code:33946
Practice Address - Country:US
Practice Address - Phone:727-367-5450
Practice Address - Fax:727-367-5630
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2240272163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management