Provider Demographics
NPI:1124322706
Name:SUTTELL, LAUREN (ARNP)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:SUTTELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:S
Other - Last Name:ULLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1830
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:900 CARILLON PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1119
Practice Address - Country:US
Practice Address - Phone:727-561-0912
Practice Address - Fax:727-561-9306
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9255773363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007742300Medicaid
FLEH840WMedicare PIN
FL007742300Medicaid