=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619082237
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN HAMMERLING-HODGERS PA-C, MPAS, DFAAPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8045 SPYGLASS HILL RD STE 104
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-8567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-294-5800
-----------------------------------------------------
Fax | 321-241-4578
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 VILLAGE SQUARE XING STE 290
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-360-2792
-----------------------------------------------------
Fax | 239-666-9211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9101668
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------