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: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 34TH ST S
SAINT PETERSBURG FL
33711-4552
US

IV. Provider business mailing address

4611 34TH ST S
ST PETERSBURG FL
33711-4552
US

V. Phone/Fax

Practice location:
  • Phone: 727-761-1318
  • Fax: 727-295-0222
Mailing address:
  • Phone: 727-761-1318
  • Fax: 727-295-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: