Healthcare Provider Details

I. General information

NPI: 1376977447
Provider Name (Legal Business Name): SUSAN L MCCRACKEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 LAKE WORTH RD
GREENACRES FL
33463-3074
US

IV. Provider business mailing address

PO BOX 740177
BOYNTON BEACH FL
33474-0177
US

V. Phone/Fax

Practice location:
  • Phone: 561-740-2900
  • Fax: 561-434-4618
Mailing address:
  • Phone: 561-740-2900
  • Fax: 561-740-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2223382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: