Healthcare Provider Details

I. General information

NPI: 1265699854
Provider Name (Legal Business Name): A SUSAN NELSON, ARNP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 NW FEDERAL HWY
STUART FL
34994-9631
US

IV. Provider business mailing address

3098 SE BUR ST
PORT SAINT LUCIE FL
34952-5855
US

V. Phone/Fax

Practice location:
  • Phone: 772-692-3140
  • Fax: 772-692-3144
Mailing address:
  • Phone: 772-692-3140
  • Fax: 772-692-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number3039062
License Number StateFL

VIII. Authorized Official

Name: DR. A SUSAN NELSON
Title or Position: CLINICAL NURSE SPECIALIST
Credential: PH.D., ARNP
Phone: 772-692-3140