Healthcare Provider Details

I. General information

NPI: 1588637565
Provider Name (Legal Business Name): SUSAN J FOSNOT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CORBETT ST SUITE 400
BELLEAIR FL
33756-7309
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 727-462-2229
  • Fax: 727-447-5610
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number058516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: