Provider Demographics
NPI:1487738787
Name:FREEMAN, SALLY ANN (ARNP, CPNP)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18631 LE DAUPHINE PL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2886
Mailing Address - Country:US
Mailing Address - Phone:813-789-3642
Mailing Address - Fax:813-932-0667
Practice Address - Street 1:3191 CLAY MANGUM LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2501
Practice Address - Country:US
Practice Address - Phone:813-264-3807
Practice Address - Fax:813-264-8931
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2814692363LF0000X, 363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health