Healthcare Provider Details

I. General information

NPI: 1023446341
Provider Name (Legal Business Name): SUSAN CHASE EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 RESEARCH PKWY SUITE 300
ORLANDO FL
32826-3298
US

IV. Provider business mailing address

12201 RESEARCH PKWY SUITE 300
ORLANDO FL
32826-3298
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-6274
  • Fax: 407-823-5508
Mailing address:
  • Phone: 407-823-6274
  • Fax: 407-823-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number704662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: