Healthcare Provider Details

I. General information

NPI: 1265832836
Provider Name (Legal Business Name): SUSAN SHEPHERD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E NEW HAVEN AVE SUITE 1
MELBOURNE FL
32901-4576
US

IV. Provider business mailing address

1326 PAPERMILL POINTE WAY
KNOXVILLE TN
37909-1903
US

V. Phone/Fax

Practice location:
  • Phone: 321-729-8223
  • Fax:
Mailing address:
  • Phone: 865-673-5000
  • Fax: 865-588-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9332611
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number24220
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: