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General NPI Number Information
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NPI Number | 1952325763
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Entity Type | Individual
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Provider Name | SUSAN W LLARENA P.A.-C.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 1340 S 18TH ST #204
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4799
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Country | US
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Telephone | 904-261-0643
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Fax | 904-277-4082
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 877-856-3774
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Fax | 239-599-2612
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 2061
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License Number State | FL
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