Provider Demographics
NPI:1760044317
Name:SARNO, KIM SUZANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:SUZANNE
Last Name:SARNO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 SE GALT CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6342
Mailing Address - Country:US
Mailing Address - Phone:772-634-1669
Mailing Address - Fax:
Practice Address - Street 1:672 SW PRIMA VISTA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1820
Practice Address - Country:US
Practice Address - Phone:442-905-2555
Practice Address - Fax:772-336-8153
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF06192525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1760044317Medicaid