Provider Demographics
NPI:1912459728
Name:DESRUISSEAU-REVIS, LINDA (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DESRUISSEAU-REVIS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CATTLEMEN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6058
Mailing Address - Country:US
Mailing Address - Phone:941-342-8892
Mailing Address - Fax:941-342-8893
Practice Address - Street 1:3333 CATTLEMEN RD STE 202
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6058
Practice Address - Country:US
Practice Address - Phone:941-342-8892
Practice Address - Fax:941-342-8893
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9490973363LF0000X
FLAPRN9490973363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48EHIOtherFLORIDA BLUE
FL6287578OtherUNITED
FL5030780OtherAETNA
FL101395400Medicaid
FL8270292OtherCIGNA