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General NPI Number Information
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NPI Number | 1124737895
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Entity Type | Individual
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Provider Name | SUSAN SROKA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 1956 E 79TH ST
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City | CLEVELAND
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State | OH
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Zip | 44103-4270
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Country | US
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Telephone | 714-625-5603
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Fax |
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Provider Business Mailing Address
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Address Line | 15002 OLD OAK DR
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City | STRONGSVILLE
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State | OH
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Zip | 44149-4873
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Country | US
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Telephone | 714-625-4503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95084373
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LE-00044330
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License Number State | OH
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