MEDICARE: SUSEL MENDOZA 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	11045486	FL
2	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1821500091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSEL MENDOZA ARNP

Provider Business Mailing Address
First Line	:	514 SW 4TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1917
Country	:	US
Telephone Number	:	305-417-2094
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 SW 4TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1917
Country	:	US
Telephone Number	:	305-417-2094
Fax Number	:

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

Provider Enumeration Date	:	10/28/2017
Last Update Date	:	03/10/2026

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