1053457655 NPI number — MRS. SONJA M. O'FLYNN ARNP

Table of content: MRS. SONJA M. O'FLYNN ARNP (NPI 1053457655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053457655 NPI number — MRS. SONJA M. O'FLYNN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'FLYNN
Provider First Name:
SONJA
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053457655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4250 PLAYERS PL
Provider Second Line Business Mailing Address:
UNIT 2617
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34238-5450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-926-9174
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2223 N WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
GENESIS HEALTH SERVICES, INC
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-957-1970
Provider Business Practice Location Address Fax Number:
941-957-1960
Provider Enumeration Date:
01/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  ARNP2545292 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)