Provider Demographics
NPI:1215809256
Name:SR NP SERVICES LLC
Entity type:Organization
Organization Name:SR NP SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDY-RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:396-339-2021
Mailing Address - Street 1:245 WOODSTOCK CT
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4863
Mailing Address - Country:US
Mailing Address - Phone:396-339-2021
Mailing Address - Fax:
Practice Address - Street 1:1275 W GRANADA BLVD STE 6A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8105
Practice Address - Country:US
Practice Address - Phone:386-339-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty