Provider Demographics
NPI:1750307179
Name:SAULSBERY, SUSAN KATHRYN (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATHRYN
Last Name:SAULSBERY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9237022363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S20025Medicare UPIN