Healthcare Provider Details

I. General information

NPI: 1568558880
Provider Name (Legal Business Name): SUSAN LUISETTE DUPREE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S OSPREY AVE
SARASOTA FL
34239-3511
US

IV. Provider business mailing address

1079 TAMIAMI TRL N
NOKOMIS FL
34275-2163
US

V. Phone/Fax

Practice location:
  • Phone: 941-953-5800
  • Fax: 941-953-5808
Mailing address:
  • Phone: 941-223-1388
  • Fax: 941-365-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1581742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: