MEDICARE: MRS. SUZANNE GANZAK CARNILL LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA35289	FL

General Provider Information

NPI Number	:	1104989185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE GANZAK CARNILL LMT

Provider Business Mailing Address
First Line	:	127 SANDOLLAR DR
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-5144
Country	:	US
Telephone Number	:	850-235-2672
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 SANDOLLAR DR
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-5144
Country	:	US
Telephone Number	:	850-235-2672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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