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NPI Code Detail

MEDICARE: MRS. SUSAN WILLIAMS THORNTON ARNP

MEDICARE: MRS. SUSAN WILLIAMS THORNTON ARNP
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
1363LF0000XFamily Nurse Practitioner9238665FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OH831OTHERFLMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2RPLQIOTHERFLBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306246723
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN WILLIAMS THORNTON ARNP
Provider Business Mailing Address
First Line : 2675 WINKLER AVE FL 2
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-9342
Country : US
Telephone Number : 877-856-3774
Fax Number :
Provider Business Practice Location Address
First Line : 1250 S 18TH ST STE 202
Second Line :
City : FERNANDINA BEACH
State : FL
Zip : 32034-4729
Country : US
Telephone Number : 904-277-4690
Fax Number : 904-277-8487
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2014
Last Update Date : 01/11/2022

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