Healthcare Provider Details

I. General information

NPI: 1821500091
Provider Name (Legal Business Name): SUSEL MENDOZA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSEL MENDOZA MARIN ARNP

II. Dates (important events)

Enumeration Date: 10/28/2017
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 SW 4TH ST
CAPE CORAL FL
33991-1917
US

IV. Provider business mailing address

514 SW 4TH ST
CAPE CORAL FL
33991-1917
US

V. Phone/Fax

Practice location:
  • Phone: 305-417-2094
  • Fax:
Mailing address:
  • Phone: 305-417-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11045486
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: