Healthcare Provider Details

I. General information

NPI: 1326953373
Provider Name (Legal Business Name): SUSAN MARIE OLSEN GODOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 POINCIANA DR
NAPLES FL
34105-2751
US

IV. Provider business mailing address

2451 POINCIANA DR
NAPLES FL
34105-2751
US

V. Phone/Fax

Practice location:
  • Phone: 239-601-7192
  • Fax:
Mailing address:
  • Phone: 239-601-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: