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General NPI Number Information
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NPI Number | 1275739880
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Entity Type | Individual
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Provider Name | SUSAN K CONRAD ARNP
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Gender | Female
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 1516 PASADENA AVE S. #300
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City | S. PASADENA
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State | FL
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Zip | 33707-1223
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Country | US
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Telephone | 727-490-3030
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Fax | 727-384-6167
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Provider Business Mailing Address
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Address Line | 1615 PASADENA AVE S SUITE #300
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City | S PASADENA
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State | FL
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Zip | 33707-4516
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Country | US
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Telephone | 727-490-3030
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Fax | 727-384-6167
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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 | ARNP739662
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License Number State | FL
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