Healthcare Provider Details

I. General information

NPI: 1639533011
Provider Name (Legal Business Name): SUSAN MARIE WAYNES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARIE RAMEY

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 BRADFORD CIR
LYNN HAVEN FL
32444-4760
US

IV. Provider business mailing address

13800 PANAMA CITY BEACH PKWY # 141
PANAMA CITY BEACH FL
32407-2865
US

V. Phone/Fax

Practice location:
  • Phone: 850-258-7680
  • Fax:
Mailing address:
  • Phone: 850-258-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9294119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: