Healthcare Provider Details

I. General information

NPI: 1407808751
Provider Name (Legal Business Name): SUSAN AMANDA COOKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN AMANDA KLEDZIK

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-8290
  • Fax: 904-244-4687
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: