Individual
MS. JUDITH E SALLUSTIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1135
(352) 376-1611
(352) 379-4048
Mailing address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1135
(352) 376-1611
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9100643
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290970700
—
FL
Enumeration date
07/27/2006
Last updated
04/05/2013
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