Healthcare Provider Details

I. General information

NPI: 1194858894
Provider Name (Legal Business Name): SUSAN TAYLOR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD
BAY PINES FL
33744
US

IV. Provider business mailing address

121 30TH ST W
BRADENTON FL
34205-4244
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 941-746-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP3213802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: