Provider Demographics
NPI:1407232705
Name:STROUT, BILLIE
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:STROUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SE WILLOUGHBY BLVD.
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-480-4718
Mailing Address - Fax:
Practice Address - Street 1:3501 SE WILLOUGHBY BLVD.
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-288-0304
Practice Address - Fax:772-288-1371
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9264271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily