MEDICARE: SUSAN M STOVALL 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	RN063851	GA
2	363LF0000X	Family Nurse Practitioner	ARNP9436002	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	:	1851727069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M STOVALL NP

Provider Business Mailing Address
First Line	:	501 LIVE OAK ST STE B
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7300
Country	:	US
Telephone Number	:	386-424-5248
Fax Number	:	386-424-5249

Provider Business Practice Location Address
First Line	:	501 LIVE OAK ST STE B
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7300
Country	:	US
Telephone Number	:	386-424-5248
Fax Number	:	386-424-5249

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

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	05/14/2020

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Directions to “ SUSAN M STOVALL NP” Practice Location

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