Healthcare Provider Details

I. General information

NPI: 1831391275
Provider Name (Legal Business Name): SUSAN L. PHILLIPS A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3383 MARINER BLVD
SPRING HILL FL
34609-2461
US

IV. Provider business mailing address

3383 MARINER BLVD
SPRING HILL FL
34609-2461
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-9499
  • Fax: 352-666-2857
Mailing address:
  • Phone: 352-683-9499
  • Fax: 352-666-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberA.P. 1520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: