Healthcare Provider Details

I. General information

NPI: 1407815632
Provider Name (Legal Business Name): SUSANNA KAY STEWART CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANNA KAY LINDSEY CRNA

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST UFJP ANESTHESIA DEPT
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-393-5582
  • Fax: 904-244-4908
Mailing address:
  • Phone: 904-244-3199
  • Fax: 904-244-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209002176
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9214586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: