Healthcare Provider Details

I. General information

NPI: 1285629998
Provider Name (Legal Business Name): SUZANNE LESTA REITER MSN, WHNP-BC, FAANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 ULMERTON RD
LARGO FL
33771-3832
US

IV. Provider business mailing address

1480 GULF BLVD #806
CLEARWATER FL
33767
US

V. Phone/Fax

Practice location:
  • Phone: 727-524-4410
  • Fax: 727-524-4410
Mailing address:
  • Phone: 616-745-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704094692
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704094692
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2972182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: