Healthcare Provider Details

I. General information

NPI: 1659788693
Provider Name (Legal Business Name): SUSAN ELIZABETH O'NEILL MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 N FEDERAL HWY STE 300
FORT LAUDERDALE FL
33308-4609
US

IV. Provider business mailing address

4750 N FEDERAL HWY STE 300
FORT LAUDERDALE FL
33308-4609
US

V. Phone/Fax

Practice location:
  • Phone: 754-206-2420
  • Fax: 954-867-5583
Mailing address:
  • Phone: 754-206-2420
  • Fax: 754-223-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN 9264748
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN 9264748
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9264748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: