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General NPI Number Information
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NPI Number | 1245049717
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Entity Type | Individual
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Provider Name | SUSANNAH DURRANCE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 870 DUNLAWTON AVE STE 210
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City | PORT ORANGE
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State | FL
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Zip | 32127-9274
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Country | US
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Telephone | 386-243-4856
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 935921
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City | ATLANTA
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State | GA
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Zip | 31193-5921
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11037241
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License Number State | FL
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