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General NPI Number Information
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NPI Number | 1154384436
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Entity Type | Individual
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Provider Name | SUSAN A HOLE D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 346 N RIDGEWOOD AVE SUITE A
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City | EDGEWATER
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State | FL
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Zip | 32132-1671
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Country | US
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Telephone | 386-423-1888
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Fax | 386-423-2030
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Provider Business Mailing Address
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Address Line | 346 N RIDGEWOOD AVE SUITE A
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City | EDGEWATER
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State | FL
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Zip | 32132-1671
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Country | US
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Telephone | 386-423-1888
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Fax | 386-423-2030
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS0006977
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License Number State | FL
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