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General NPI Number Information
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NPI Number | 1417880840
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Entity Type | Individual
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Provider Name | LANDIE SUFRALIEN
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Gender | Female
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 110 MELALEUCA DR
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City | CRAWFORDVILLE
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State | FL
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Zip | 32327-4963
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Country | US
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Telephone | 850-410-1895
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Fax |
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Provider Business Mailing Address
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Address Line | 501 S BLAIR STONE RD APT 1621
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City | TALLAHASSEE
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State | FL
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Zip | 32301-3033
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Country | US
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Telephone | 850-688-5083
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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 | F06260354
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License Number State | FL
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