MEDICARE: SUSAN MARY MINTER CRNP

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	0024167550	VA

General Provider Information

NPI Number	:	1740477454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARY MINTER CRNP

Provider Business Mailing Address
First Line	:	21344 RACE HORSE LN
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-6735
Country	:	US
Telephone Number	:	571-214-6755
Fax Number	:

Provider Business Practice Location Address
First Line	:	21344 RACE HORSE LN
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-6735
Country	:	US
Telephone Number	:	571-214-6755
Fax Number	:

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	06/28/2020

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