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General NPI Number Information
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NPI Number | 1619918042
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Entity Type | Individual
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Provider Name | SUZANNE MITCHELL BRULTE MD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 14011 BEACH BLVD UNIT 120
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City | JACKSONVILLE
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State | FL
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Zip | 32250-1694
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Country | US
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Telephone | 904-223-6400
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Fax | 904-223-6420
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Provider Business Mailing Address
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Address Line | 3839 COUNTY ROAD 218
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City | MIDDLEBURG
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State | FL
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Zip | 32068-5708
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Country | US
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Telephone | 904-379-7155
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Fax | 904-379-7165
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME89658
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME89658
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME89658
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License Number State | FL
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