MEDICARE: SUSAN PHAM NP

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	363L00000X	Nurse Practitioner	11002867	FL
2	363LF0000X	Family Nurse Practitioner	11002867	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	:	1407418296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PHAM NP

Provider Business Mailing Address
First Line	:	875 E NINE MILE RD STE 6
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-1708
Country	:	US
Telephone Number	:	850-542-7413
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 E NINE MILE RD STE 6
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-1708
Country	:	US
Telephone Number	:	850-542-7413
Fax Number	:

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

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	02/19/2025

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Directions to “ SUSAN PHAM NP” Practice Location

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