MEDICARE: GINA SUSSI ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F303615-1	NY
2	363LA2200X	Adult Health Nurse Practitioner	APRN9342254	FL

General Provider Information

NPI Number	:	1164579868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA SUSSI ARNP

Provider Business Mailing Address
First Line	:	100 3RD AVE W STE 110
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8641
Country	:	US
Telephone Number	:	941-708-9555
Fax Number	:	941-708-5465

Provider Business Practice Location Address
First Line	:	3005 CARING WAY STE 1
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5304
Country	:	US
Telephone Number	:	941-708-9555
Fax Number	:	941-708-5465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	02/04/2026

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