Healthcare Provider Details

I. General information

NPI: 1437203486
Provider Name (Legal Business Name): SUSAN MARGARET SKOUFATOS R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARGARET PECARD R.N.

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5623 US HIGHWAY 19 SUITE 303
NEW PORT RICHEY FL
34652-3700
US

IV. Provider business mailing address

10927 NORWOOD AVE
PORT RICHEY FL
34668-2524
US

V. Phone/Fax

Practice location:
  • Phone: 727-841-9050
  • Fax: 727-841-8145
Mailing address:
  • Phone: 727-863-0991
  • Fax: 727-841-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2805262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: