Healthcare Provider Details

I. General information

NPI: 1649130337
Provider Name (Legal Business Name): SUSAN PERSAUD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 TAMPA RD STE V-W
PALM HARBOR FL
34684-3152
US

IV. Provider business mailing address

2595 TAMPA RD STE V-W
PALM HARBOR FL
34684-3152
US

V. Phone/Fax

Practice location:
  • Phone: 727-712-1567
  • Fax:
Mailing address:
  • Phone: 727-712-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11041167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: