Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 N MCMULLEN BOOTH RD STE 202
CLEARWATER FL
33761-2013
US

IV. Provider business mailing address

3190 N MCMULLEN BOOTH RD STE 202
CLEARWATER FL
33761-2013
US

V. Phone/Fax

Practice location:
  • Phone: 727-953-9347
  • Fax: 727-269-5060
Mailing address:
  • Phone: 727-953-9347
  • Fax: 727-269-5060

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: