Healthcare Provider Details

I. General information

NPI: 1255714093
Provider Name (Legal Business Name): SUSANNA MARIA HUHTAMAKI AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 09/26/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S KANNER HWY STE 300
STUART FL
34994-4801
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-4978
  • Fax: 772-223-2827
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3291492
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3291492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: