MEDICARE: SUSAN GRAY SHIRLEY 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	363LF0000X	Family Nurse Practitioner	ARNP 2733542	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346483856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN GRAY SHIRLEY ARNP

Provider Business Mailing Address
First Line	:	4337 KEYSVILLE RD
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-1601
Country	:	US
Telephone Number	:	813-737-1953
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 CHARLOTTE PARK DR
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1956
Country	:	US
Telephone Number	:	813-977-2777
Fax Number	:

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	10/16/2014

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