Healthcare Provider Details

I. General information

NPI: 1063930147
Provider Name (Legal Business Name): SUSAN ANNE SCHMALTZ APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 W PASO TRI
PHOENIX AZ
85085
US

IV. Provider business mailing address

222 LAKEVIEW AVE STE 735
WEST PALM BEACH FL
33401-6145
US

V. Phone/Fax

Practice location:
  • Phone: 231-432-5841
  • Fax:
Mailing address:
  • Phone: 231-432-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10363
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP10363
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: