Healthcare Provider Details

I. General information

NPI: 1871761890
Provider Name (Legal Business Name): SUSAN NICHOLSON LAJOIE ARNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 DR. LASALLE LEFFALL DR.
QUINCY FL
32351
US

IV. Provider business mailing address

278 DR. LASALLE LEFFALL DR.
QUINCY FL
32351
US

V. Phone/Fax

Practice location:
  • Phone: 850-539-2888
  • Fax: 850-539-2766
Mailing address:
  • Phone: 850-539-2888
  • Fax: 850-539-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number1568462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: