Healthcare Provider Details

I. General information

NPI: 1619833019
Provider Name (Legal Business Name): SUSAN NICOLE RICE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 CHESTER AVE STE 1
JACKSONVILLE FL
32217-2279
US

IV. Provider business mailing address

608 LYNDSEY LN
WINTER HAVEN FL
33884-2254
US

V. Phone/Fax

Practice location:
  • Phone: 904-265-8209
  • Fax: 904-503-3577
Mailing address:
  • Phone: 518-646-3620
  • Fax: 904-503-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11044273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: