Provider Demographics
NPI:1407564180
Name:SUTPHEN, CARMEN MARIE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARIE
Last Name:SUTPHEN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:MELENDREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:943 S BENEVA RD STE 306
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2499
Mailing Address - Country:US
Mailing Address - Phone:941-955-1108
Mailing Address - Fax:
Practice Address - Street 1:921 S BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2401
Practice Address - Country:US
Practice Address - Phone:941-365-7390
Practice Address - Fax:941-365-5469
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023005363L00000X
FL11023005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner