Healthcare Provider Details

I. General information

NPI: 1538186416
Provider Name (Legal Business Name): SUSAN V KLIMA A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN V. CANIPELLI A.R.N.P.

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 EAGLE HARBOR PKWY SUITE A
ORANGE PARK FL
32003-4806
US

IV. Provider business mailing address

PO BOX 16568
JACKSONVILLE FL
32245-6568
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-9555
  • Fax: 904-215-7960
Mailing address:
  • Phone: 904-472-2300
  • Fax: 904-472-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP 627972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: