Healthcare Provider Details

I. General information

NPI: 1689939282
Provider Name (Legal Business Name): SUSAN C MASON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 WESTLINKS DR STE 103
FORT MYERS FL
33913-8001
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-5050
  • Fax: 239-343-4241
Mailing address:
  • Phone: 239-541-4420
  • Fax: 239-541-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9478030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: