Healthcare Provider Details

I. General information

NPI: 1922332741
Provider Name (Legal Business Name): SUSAN ANTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 BOCA CIEGA ISLE DR
ST PETE BEACH FL
33706-2532
US

IV. Provider business mailing address

PO BOX 67296
ST PETE BEACH FL
33736-7296
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-2571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9217619
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number546842
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: