Healthcare Provider Details

I. General information

NPI: 1578376596
Provider Name (Legal Business Name): SUSAN SCHAILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 72ND AVE N
PINELLAS PARK FL
33781-4047
US

IV. Provider business mailing address

6580 72ND AVE N
PINELLAS PARK FL
33781-4047
US

V. Phone/Fax

Practice location:
  • Phone: 727-440-5612
  • Fax:
Mailing address:
  • Phone: 727-440-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11037538
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: