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General NPI Number Information
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NPI Number | 1790303485
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Entity Type | Individual
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Provider Name | SUSED HIDALGO
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 2010 NW 150TH AVE STE 120
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2888
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Country | US
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Telephone | 786-344-1403
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Fax |
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Provider Business Mailing Address
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Address Line | 5656 W 25TH CT
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City | HIALEAH
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State | FL
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Zip | 33016-4402
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Country | US
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Telephone | 786-344-1403
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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 | 11007271
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11007271
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License Number State | FL
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