Healthcare Provider Details

I. General information

NPI: 1104765601
Provider Name (Legal Business Name): SUZANNE MARY EATON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 CLEARLAKE RD # 1016
COCOA FL
32922-6384
US

IV. Provider business mailing address

1066 CLEARLAKE RD # 1016
COCOA FL
32922-6384
US

V. Phone/Fax

Practice location:
  • Phone: 321-290-3715
  • Fax:
Mailing address:
  • Phone: 321-290-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberX9E5C8G7
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: