Healthcare Provider Details

I. General information

NPI: 1457582009
Provider Name (Legal Business Name): SUSAN GARBOTZ MCKENZIE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARIE SHAFFER ARNP

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 US HWY 98 W SUITE 104
SANTA ROSA BEACH FL
32459
US

IV. Provider business mailing address

4821 US HWY 98 W SUITE 104
SANTA ROSA BEACH FL
32459
US

V. Phone/Fax

Practice location:
  • Phone: 850-622-2055
  • Fax: 850-622-2053
Mailing address:
  • Phone: 850-622-2055
  • Fax: 850-622-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberARNP9369453
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9369453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: