Provider Demographics
NPI:1609035773
Name:SLR-ARNP, LLC
Entity Type:Organization
Organization Name:SLR-ARNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PSYCHIATRIC NURSE PRACTITION
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUX
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-BC
Authorized Official - Phone:941-379-9110
Mailing Address - Street 1:3402 MAGIC OAK LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1812
Mailing Address - Country:US
Mailing Address - Phone:941-379-9110
Mailing Address - Fax:941-343-9110
Practice Address - Street 1:3402 MAGIC OAK LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1812
Practice Address - Country:US
Practice Address - Phone:941-379-9110
Practice Address - Fax:941-343-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9223141363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3090337 00Medicaid