Healthcare Provider Details

I. General information

NPI: 1922356989
Provider Name (Legal Business Name): SUSAN AMANDA BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2012
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 SUN N LAKE BLVD STE 105
SEBRING FL
33872-2171
US

IV. Provider business mailing address

4325 SUN N LAKE BLVD STE 105
SEBRING FL
33872-2171
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-2248
  • Fax: 863-382-1242
Mailing address:
  • Phone: 863-382-2248
  • Fax: 863-382-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17991
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11010315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: