Healthcare Provider Details

I. General information

NPI: 1619082237
Provider Name (Legal Business Name): SUSAN HAMMERLING-HODGERS PA-C, MPAS, DFAAPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN HAMMERLING-HODGERS

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 SPYGLASS HILL RD STE 104
MELBOURNE FL
32940-8567
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 290
PALM BEACH GARDENS FL
33410-4552
US

V. Phone/Fax

Practice location:
  • Phone: 321-294-5800
  • Fax: 321-241-4578
Mailing address:
  • Phone: 239-360-2792
  • Fax: 239-666-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: