Healthcare Provider Details

I. General information

NPI: 1306246723
Provider Name (Legal Business Name): SUSAN WILLIAMS THORNTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S 18TH ST STE 202
FERNANDINA BEACH FL
32034-4729
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 904-277-4690
  • Fax: 904-277-8487
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9238665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: