Healthcare Provider Details

I. General information

NPI: 1124859566
Provider Name (Legal Business Name): SUSAN MICHELLE RUDAY MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEERFIELD PRESERVE BLVD
ST AUGUSTINE FL
32086-5966
US

IV. Provider business mailing address

100 DEERFIELD PRESERVE BLVD
ST AUGUSTINE FL
32086-5966
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-0814
  • Fax:
Mailing address:
  • Phone: 904-829-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9618483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: